Time trends and predictors of laboratory-confirmed recurrent and severe
Aged
Aged, 80 and over
Clostridioides difficile
Clostridium Infections
/ diagnosis
Cohort Studies
Cross Infection
/ epidemiology
Databases, Factual
Female
Humans
Incidence
Infectious Disease Medicine
/ trends
Male
Manitoba
/ epidemiology
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Recurrence
Journal
CMAJ open
ISSN: 2291-0026
Titre abrégé: CMAJ Open
Pays: Canada
ID NLM: 101620603
Informations de publication
Date de publication:
Historique:
entrez:
17
11
2020
pubmed:
18
11
2020
medline:
18
11
2020
Statut:
epublish
Résumé
Many previous studies of We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included ( Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital. Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.
Sections du résumé
BACKGROUND
Many previous studies of
METHODS
We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included (
RESULTS
Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital.
INTERPRETATION
Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.
Identifiants
pubmed: 33199507
pii: 8/4/E737
doi: 10.9778/cmajo.20190191
pmc: PMC7676992
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
E737-E746Informations de copyright
Copyright 2020, Joule Inc. or its licensors.
Déclaration de conflit d'intérêts
Competing interests: Harminder Singh has been on advisory boards or served as a consultant to Takeda Canada, Pendopharm, Ferring Canada, Merck Canada and Guardant Health, Inc. and has received an educational grant from Ferring Canada and research funding from Merck Canada for an independent investigator grant. Charles Bernstein has served on advisory boards or as a consultant to AbbVie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada and Mylan Pharmaceuticals and has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Pfizer Canada, Shire Canada and Takeda Canada. He has been on the speaker’s bureau for Janssen Canada, Takeda Canada, Ferring Canada and Medtronic Canada. Laura Targownik has served on the advisory boards for Pfizer Canada, Takeda Canada, AbbVie Canada and Janssen Canada and on speaker panels for Janssen Canada, Takeda Canada and Pfizer Canada. She has received grant support from Pfizer Canada and AbbVie Canada. No other competing interests were declared.
Références
Infect Control Hosp Epidemiol. 2002 Mar;23(3):137-40
pubmed: 11918118
Gut Liver. 2019 Jan 15;13(1):16-24
pubmed: 30400734
Diabetes Res Clin Pract. 2014 Sep;105(3):285-94
pubmed: 25015315
Clin Infect Dis. 2011 Jul 1;53(1):20-5
pubmed: 21653298
Diagn Microbiol Infect Dis. 2002 Aug;43(4):257-63
pubmed: 12151184
J Clin Microbiol. 2012 Mar;50(3):867-75
pubmed: 22162545
Infect Control Hosp Epidemiol. 2010 Oct;31(10):1030-7
pubmed: 20695799
Curr Treat Options Gastroenterol. 2017 Dec;15(4):460-474
pubmed: 29063998
Ann Pharmacother. 1998 Nov;32(11):1152-7
pubmed: 9825079
Infect Control Hosp Epidemiol. 2015 Apr;36(4):452-60
pubmed: 25626326
Can J Public Health. 2012 Jul 04;103(8 Suppl 2):S23-7
pubmed: 23618067
Stat Med. 2000 Feb 15;19(3):335-51
pubmed: 10649300
Med Care. 1997 Sep;35(9):932-47
pubmed: 9298082
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
PLoS One. 2017 Mar 3;12(3):e0172410
pubmed: 28257438
Infect Control Hosp Epidemiol. 2007 Feb;28(2):140-5
pubmed: 17265394
CMAJ. 2018 Jun 25;190(25):E758-E765
pubmed: 29941432
Clin Infect Dis. 2018 Mar 19;66(7):987-994
pubmed: 29562266
J Clin Microbiol. 2014 Jul;52(7):2406-9
pubmed: 24759727
Am J Epidemiol. 1999 May 15;149(10):916-24
pubmed: 10342800
N Engl J Med. 2015 Apr 16;372(16):1539-48
pubmed: 25875259
Eur J Clin Microbiol Infect Dis. 2019 Jul;38(7):1211-1221
pubmed: 30945014
J Clin Microbiol. 2013 Apr;51(4):1152-7
pubmed: 23363829
PLoS One. 2017 Feb 15;12(2):e0171266
pubmed: 28199401
Ann Intern Med. 2017 Aug 1;167(3):152-158
pubmed: 28672282
Dig Dis Sci. 2015 Oct;60(10):2913-22
pubmed: 25986528
Med Care. 1993 Mar;31(3):201-12
pubmed: 8450678
Infect Control Hosp Epidemiol. 2009 Oct;30(10):945-51
pubmed: 19732008