Estimated Incidence of Clostridium difficile Infection.To the Editor: Since the publication of our article Increasing hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. and death, possibly due to Clostridium difficile Clostridium difficile A common cause of bacterial colitis; it is the causative agent in 99% of pseudomembranous colitis, and 20-30% of antibiotic-associated diarrhea diarrheal disease (1), we have received several requests to estimate the incidence of C. difficile infection. Our original study included only hospitalized patients treated at the Lovelace Medical Center from 1993 to 1996, and no information on the incidence of C. difficile infection. In response to these requests, we used inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay. in·pa·tient n. and outpatient medical claims for the Lovelace managed care population to calculate incidence rates. We searched medical claims for the Lovelace Health Plan/Senior Plan (LHP LHP Left-Handed Pitcher LHP Left Hand Path LHP Lighthouse Point (Broward County, Florida city) LHP Left Half-Plane LHP Lead Hollowpoint (bullet) LHP Living History Project LHP Landslide Hazard Program ) to identify patients who had a C. difficile diagnosis between January 1, 1993, and December 31, 1997. LHP members are residents of New Mexico New Mexico, state in the SW United States. At its northwestern corner are the so-called Four Corners, where Colorado, New Mexico, Arizona, and Utah meet at right angles; New Mexico is also bordered by Oklahoma (NE), Texas (E, S), and Mexico (S). , most residing in or near Albuquerque. LHP had approximately 713,000 person-years of enrollment from 1993 to 1997. We identified 104 members with a C. difficile diagnosis on a claims record during this period. This group includes most of the patients in our original study. Most patients (62.5%) were identified exclusively from inpatient records; another 15.4% had both an inpatient and an outpatient record with a C. difficile diagnosis; and 22.1% had only an outpatient C. difficile diagnosis. We calculated an age-adjusted rate of infection (adjusted to the 1990 U.S. population), for each year and for the 5-year period. The incidence of C difficile infection for all members during 1993 to 1997 was 14.8 cases per 100,000 person-years of enrollment. The patients rates for male and female were essentially the same (14.4 vs. 15.5, respectively). The rates increased dramatically with age. For persons ages 0-4, the age-adjusted rate per 100,000 person-years of enrollment (number of cases) was 5.3 (2); for 5-14, 2.7 (3), for 1524, 2.2 (2); for 24-34, 6.4 (6); for 35-44, 9.2 (12); for 45-54, 15.7 (17); 55-64, 16.8 (10); 65-74, 38.5 (19); and 75+, 98.9 (33). The overall average rate of infection was 15.4; there were 104 cases. The rate of infection may have declined since 1993 in this population. The 1993 rate was 24.5 per 100,000 person-years of enrollment, declining to 11.1 in 1997 (1993, 24.4; 1994, 19.1; 1995, 9.9; 1996, 12.3; and 1997, 11.1). Our method for estimating rates has some limitations. We did not examine laboratory records to confirm the diagnosis. In addition, some laboratory-confirmed infections may not have resulted in a claims record with a C. difficile diagnosis. The Lovelace managed-care population is an insured, generally healthy population that may not have the characteristics of patients in other health care delivery settings or, because of its geographic restriction, the characteristics of the general U.S. population. Nevertheless, these estimates provide a basis for determining the magnitude of the public health problem of C. difficile infection. Additional surveillance studies are needed to better estimate the incidence of infection and to determine whether the incidence has declined during recent years. Reference (1.) Frost F, Craun GF, Calderon RL. Increasing hospitalization and death possibly due to Clostridium difficile diarrheal disease. Emerg Infect infect /in·fect/ (in-fekt´) 1. to invade and produce infection in. 2. to transmit a pathogen or disease to. in·fect v. 1. Dis 1998;4:619-25. Floyd Frost,(*) Judith S Judith [Heb.,=Jewess], early Jewish book included in the Septuagint, but not included in the Hebrew Bible, and placed in the Apocrypha of Protestant Bibles. It recounts an attack on the Jews by an army led by Holofernes, Nebuchadnezzar's general. . Hurley Hurley has become the English version of at least three distinct original Irish names: the Ó hUirthile, part of the Dál gCais tribal group, based in Clare and North Tipperary; the Ó Muirthile, based around Kilbritain in west Cork; and the OhIarlatha, from the district of ,(*) Hans V. Petersen,(*) and Roman N. Casciano([dagger]) (*)Southwest Center for Managed Case Research, Albuquerque, New Mexico “Albuquerque” redirects here. For other uses, see Albuquerque (disambiguation). Albuquerque (pronounced [ˈæl.bə.kɚ.kiː], Spanish: [al.βu. , USA; and ([dagger])Analytica Group, Ltd., New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , New York, USA |
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