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Journal of Clinical Microbiology, July 1998, p. 2076-2080, Vol. 36, No. 7
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Survey of Incidence of Clostridium difficile Infection in Canadian Hospitals and Diagnostic Approaches

Michelle J. Alfa,1,2,* Tim Du,1 and Gabi Beda2

Department of Medical Microbiology, University of Manitoba,1 and St. Boniface General Hospital,2 Winnipeg, Manitoba, Canada

Received 26 September 1997/Returned for modification 19 November 1997/Accepted 8 April 1998

A questionnaire relating to Clostridium difficile disease incidence and diagnostic practices was sent to 380 Canadian hospitals (all with >50 beds). The national questionnaire response rate was 63%. In-house testing was performed in 17.6, 61.5, and 74.2% of the hospitals with <300, 300 to 500, and >500 beds, respectively. The average test positivity rates were 17.2, 15.3, and 13.2% for hospitals with <300, 300 to 500, and >500 beds, respectively. The average disease incidences were 23.5, 30.8, and 40.3 cases per 100,000 patient days in the hospitals with <300, 300 to 500, and >500 beds, respectively. In the 81 hospitals where in-house testing was performed, cytotoxin testing utilizing tissue culture was most common (44.4%), followed by enzyme-linked immunosorbent assay (38.3%), culture for toxigenic C. difficile (32.1%), and latex agglutination (13.6%). The clinical criteria for C. difficile testing were variable, with 85% of hospitals indicating that a test was done automatically if ordered by a doctor. Our results show that C. difficile-associated diarrhea is a major problem in hospitals with >= 200 beds. Despite a lower disease incidence in smaller hospitals, there was a higher diagnostic test positivity rate. This may reflect the preference of smaller hospitals for culture and latex agglutination tests.

* Corresponding author. Mailing address: Microbiology, St. Boniface General Hospital, 409 Tache Ave., Winnipeg, MB R2H 2A6, Canada. Phone: (204) 237-2105. Fax: (204) 237-6065. E-mail: malfa{at}cc.umanitoba.ca.

Journal of Clinical Microbiology, July 1998, p. 2076-2080, Vol. 36, No. 7
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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