Mortality and Clostridium difficile infection in an Australian setting

Authors

  • Brett G. Mitchell RN DTropN MAdvPract,

    Assistant Director of Nursing, Corresponding author
    • School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
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  • Anne Gardner MPH PhD RN,

    Professor, Research Associate
    1. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
    2. National Centre for Clinical Outcomes Research (NaCCOR), Australian Catholic University, Canberra, Australian Capital Territory, Australia
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  • Janet E. Hiller MPH PhD FPHAA

    Professor
    1. Faculty of Health Sciecne, Australian Catholic University, Melbourne, Victoria, Australia
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Correspondence to B.G. Mitchell:

e-mail: bgmitc001@myacu.edu.au

Abstract

Aim

To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital.

Background

Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made.

Design

An observational non-concurrent cohort study design was used.

Methods

Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007–2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan–Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index.

Results

One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days.

Conclusion

In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities.

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