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Onset of Symptoms and Time to Diagnosis of Clostridium difficile–Associated Disease Following Discharge From an Acute Care Hospital

Heidi T. Chang , MD, MPH, Dorota Krezolek , MD, Stuart Johnson , MD, Jorge P. Parada , MD, MPH, Charlesnika T. Evans , MPH and Dale N. Gerding , MD
Infection Control and Hospital Epidemiology
Vol. 28, No. 8 (August 2007), pp. 926-931
DOI: 10.1086/519178
Stable URL: http://www.jstor.org/stable/10.1086/519178
Page Count: 6
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Onset of Symptoms and Time to Diagnosis of Clostridium difficile–Associated Disease Following Discharge From an Acute Care Hospital
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Abstract

Objective.  To identify patients with a diagnosis of Clostridium difficile–associated disease (CDAD) in the ambulatory care setting and determine the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials. Design.  Single‐center, retrospective study. Methods.  Medical records were reviewed for outpatients and hospitalized patients with a stool assay positive for C. difficile toxin A from January 1998 through March 2005. Patients with recurrent CDAD or residing in an extended‐care facility were excluded. CDAD in patients who had been hospitalized in the 100 days prior to diagnosis was considered potentially hospital‐associated. Results.  Of the 84 patients who met the inclusion criteria, 75 (89%) received a diagnosis 1‐60 days after hospital discharge (median, 12 days), and 71 (85%) received a diagnosis within 30 days after discharge. Of the 69 patients whose records contained information regarding time of symptom onset, 62 (90%) developed diarrhea within 30 days of a previous hospital discharge, including 7 patients with symptom onset prior to discharge and 9 with onset on the day of discharge. The median time from symptom onset to diagnosis was 6 days. Of 84 patients, 77 (92%) had received antimicrobials during a prior hospitalization, but 55 (65%) received antimicrobials both as inpatients and as outpatients. Conclusion.  If all cases of CDAD diagnosed within 100 days of hospital discharge were assumed to be hospital‐associated, 71 (85%) of 84 patients with CDAD were identified within 30 days, and 75 (89%) of 84 were identified by day 60. Continued outpatient antimicrobial exposure confounds determination of whether late‐onset cases are community‐ or hospital‐associated.

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