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Morbidity, Mortality, and Healthcare Burden of Nosocomial Clostridium Difficile-Associated Diarrhea in Canadian Hospitals

  • Mark A. Miller (a1), Meagan Hyland (a2), Marianna Ofner-Agostini (a2), Marie Gourdeau (a3), Magued Ishak (a4), Canadian Hospital Epidemiology Committee and Canadian Nosocomial Infection Surveillance Program...

To assess the healthcare burden, morbidity, and mortality of nosocomial Clostridium difficile-associated diarrhea (N-CDAD) in Canadian hospitals.


Laboratory-based prevalence study.


Nineteen acute-care Canadian hospitals belonging to the Canadian Hospital Epidemiology Committee surveillance program.


Hospitalized patients in the participating centers.


Laboratory-based surveillance was conducted for C. difficile toxin in stool among 19 Canadian hospitals from January to April 1997, for 6 continuous weeks or until 200 consecutive diarrhea stool samples had been tested at each site. Patients with N-CDAD had to fulfill the case definition. Data collected for each case included patient demographics, length of stay, extent of diarrhea, complications of CDAD, CDAD-related medical interventions, patient outcome, and details of death.


We found that 371 (18%) of 2,062 tested patients had stools with positive results for C. difficile toxin, of whom 269 (13%) met the case definition for nosocomial CDAD. Of these, 250 patients (93%) had CDAD during their hospitalization, and 19 (7%) were readmitted because of CDAD (average readmission stay, 13.6 days). Forty-one patients (15.2%) died, of whom 4 (1.5% of the total) were considered to have died directly or indirectly of N-CDAD. The following N-CDAD-related morbidity was noted: dehydration, 3%; hypokalemia, 2%; gastrointestinal hemorrhage requiring transfusion, 1%; bowel perforation, 0.4%; and secondary sepsis, 0.4%. The cost of N-CDAD readmissions alone was estimated to be a minimum of $128,200 (Canadian dollars) per year per facility.


N-CDAD is a common and serious nosocomial infectious complication in Canada, is associated with substantial morbidity and mortality, and imposes an important financial burden on healthcare institutions.

Corresponding author
Division of Nosocomial and Occupational Infections, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, LCDC Building, 3rd Floor, Postal Locator 060E31, Ottawa, K1A 0L2 Ontario, Canada
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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