Quebec strain of C. difficile in 7 provinces
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《加拿大医疗协会学报》
The same strain of Clostridium difficile that has caused close to 1400 deaths in Quebec since 2003 is present in 7 provinces, the Public Health Agency of Canada is reporting.
The NAP 1 strain of C. difficile was found in hospitals in Ontario, Quebec, Nova Scotia, Newfoundland and Labrador, Alberta, Saskatchewan and British Columbia. The Canadian Nosocomial Surveillance Program participated in a 6-month study conducted by the Canadian Hospital Epidemiology Association and the Public Health Agency, and involving 34 hospitals that belong to the program (Fig. 1).
From Nov. 1, 2004, to Apr. 30, 2005, the National Microbiology Laboratory in Winnipeg collected more than 2000 stool samples and epidemiological data from patients at these institutions. The Public Health Agency has so far analyzed 615 of those samples and identified 1847 cases of NAP 1. Although they have not yet found the strain in New Brunswick and Manitoba, that may be because they still have more samples to investigate, says Denise Gravel, manager of the Nosocomial and Occupational Infections section of the Public Health Agency.
Compared to Agency data from a similar 1997 study, the incidence rate of C. difficile is essentially unchanged; 5.8% per 1000 hospital admissions in 1997, and 6% in the new study. But the mortality rate has jumped by 400%. In 1997, C. difficile contributed, either directly or indirectly, to the deaths of 1.5% of patients with the infection; the new study indicates the mortality rate is 5.8%, "which of course is highly significant," Gravel says.
She says morbidity has also jumped. "We did find that those who had the NAP 1 strain are 2.3 times more likely to have a serious outcome." The study defined "serious outcome" as death, colectomy or ICU admission.
Quebec has the highest incidence rate, 13 per 1000 admissions compared with 7 per 1000 in Ontario, 3 per 1000 in Western Canada and 6 per 1000 in Atlantic Canada. There are no baseline data to allow a comparison with provincial rates in each province.
In separate data released by the Quebec government in December 2005, C. difficile is listed as the direct cause of death for 354 people in 2003 and 686 in 2004, for a total of 1040 deaths.
These official figures appear to support the estimates of Dr. Jacques Pépin, an infectious disease specialist in Sherbrooke, Que. Pépin published a paper last year (CMAJ 2005;173:1037-42) estimating that as many as 2000 people died, directly and indirectly, from C. difficile in 2003–2004.
C. difficile directly caused another 341 deaths in the first 6 months of 2005, according to the province. In total, Quebec has attributed 1381 deaths directly to C. difficile from 2003 through the first half of 2005.(Laura Eggertson)
The NAP 1 strain of C. difficile was found in hospitals in Ontario, Quebec, Nova Scotia, Newfoundland and Labrador, Alberta, Saskatchewan and British Columbia. The Canadian Nosocomial Surveillance Program participated in a 6-month study conducted by the Canadian Hospital Epidemiology Association and the Public Health Agency, and involving 34 hospitals that belong to the program (Fig. 1).
From Nov. 1, 2004, to Apr. 30, 2005, the National Microbiology Laboratory in Winnipeg collected more than 2000 stool samples and epidemiological data from patients at these institutions. The Public Health Agency has so far analyzed 615 of those samples and identified 1847 cases of NAP 1. Although they have not yet found the strain in New Brunswick and Manitoba, that may be because they still have more samples to investigate, says Denise Gravel, manager of the Nosocomial and Occupational Infections section of the Public Health Agency.
Compared to Agency data from a similar 1997 study, the incidence rate of C. difficile is essentially unchanged; 5.8% per 1000 hospital admissions in 1997, and 6% in the new study. But the mortality rate has jumped by 400%. In 1997, C. difficile contributed, either directly or indirectly, to the deaths of 1.5% of patients with the infection; the new study indicates the mortality rate is 5.8%, "which of course is highly significant," Gravel says.
She says morbidity has also jumped. "We did find that those who had the NAP 1 strain are 2.3 times more likely to have a serious outcome." The study defined "serious outcome" as death, colectomy or ICU admission.
Quebec has the highest incidence rate, 13 per 1000 admissions compared with 7 per 1000 in Ontario, 3 per 1000 in Western Canada and 6 per 1000 in Atlantic Canada. There are no baseline data to allow a comparison with provincial rates in each province.
In separate data released by the Quebec government in December 2005, C. difficile is listed as the direct cause of death for 354 people in 2003 and 686 in 2004, for a total of 1040 deaths.
These official figures appear to support the estimates of Dr. Jacques Pépin, an infectious disease specialist in Sherbrooke, Que. Pépin published a paper last year (CMAJ 2005;173:1037-42) estimating that as many as 2000 people died, directly and indirectly, from C. difficile in 2003–2004.
C. difficile directly caused another 341 deaths in the first 6 months of 2005, according to the province. In total, Quebec has attributed 1381 deaths directly to C. difficile from 2003 through the first half of 2005.(Laura Eggertson)