Assessment of administrative data for evaluating the shifting acquisition of Clostridium difficile infection in England

J Hosp Infect. 2012 Mar;80(3):229-37. doi: 10.1016/j.jhin.2012.01.001. Epub 2012 Feb 4.


Background: Little is known about the acquisition of Clostridium difficile infection (CDI) and whether it represents hospital- or community-acquired infection.

Aim: To test the feasibility and value of using national hospital admissions data from Hospital Episode Statistics to examine trends in CDI in England.

Methods: Hospital Episode Statistics from the period 1997/98 to 2009/10 were used. Time trends were analysed using two different denominators of hospital activity: total admissions and total bed-days. We explored the impact of sociodemographic factors, comorbidity and healthcare pathways on the risk of CDI.

Findings: CDI rates per admission and per bed-days increased from 1997/98 to 2006/07, then decreased significantly by >50% from 2008/9 and 2009/10. This pattern was similar for patients regardless of probable source of infection but the proportion of probable community-acquired CDI cases rose steadily from 7% in 1997/98 to 13% in 2009/10. CDI rates were higher among older patients (odds ratio: >65 years, 10.9), those with more comorbid conditions (odds ratio for Charlson index: >5, 5.6), and among patients admitted as an emergency compared with elective admissions, but no relationship was found with deprivation score.

Conclusion: Our findings support not only the falling trend in CDI found in the national mandatory surveillance scheme from the Health Protection Agency, but a growing proportion of CDI presenting on admission with no evidence of prior hospital exposure in the previous 90 days. We suggest that these may be community-acquired CDI cases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Clostridioides difficile*
  • Clostridium Infections / epidemiology*
  • Clostridium Infections / microbiology
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • England / epidemiology
  • Enterocolitis, Pseudomembranous / epidemiology*
  • Enterocolitis, Pseudomembranous / microbiology
  • Female
  • Humans
  • Male
  • Medical Records / statistics & numerical data*
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Young Adult