Hospitalizations and deaths associated with Clostridium difficile infection, Finland, 1996-2004.

To determine whether the rate of Clostridium difficile-associated disease (CDAD) and CDAD-related deaths were increasing in Finland, we analyzed registry data from 1996 through 2004. We determined the number of hospital discharges that had a diagnosis code specific for CDAD from the International Classification of Diseases, 10th revision: "enterocolitis due to Clostridium difficile" (A04.7) and "pseudomembranous enterocolitis associated with antimicrobial therapy" (K52.8), listed as any diagnosis in the National Hospital Discharge Registry. CDAD-related deaths were identified from death certificates. Those discharged with a CDAD diagnosis doubled from 810 (16/100,000 population) in 1996 to 1,787 (34/100,000) in 2004. The increase was most prominent for patients 7gt;64 years of age but concerned only those discharged with diagnosis code A04.7. The number of those discharged with diagnosis code K52.8 remained stable. The age-standardized mortality rate associated with CDAD increased from 9/million in 1998 to 17/million in 2004; the increase was limited to persons 7gt;64 years of age.

Diagnostic trends in Clostridium difficile detection in Finnish microbiology laboratories.

Due to increased interest directed to Clostridium difficile-associated infections, a questionnaire survey of laboratory diagnostics of toxin-producing C. difficile was conducted in Finland in June 2006. Different aspects pertaining to C. difficile diagnosis, such as requests and criteria used for testing, methods used for its detection, yearly changes in diagnostics since 1996, and the total number of investigations positive for C. difficile in 2005, were asked in the questionnaire, which was sent to 32 clinical microbiology laboratories, including all hospital-affiliated and the relevant private clinical microbiology laboratories in Finland. The situation was updated by phone and email correspondence in September 2008. In June 2006, 28 (88%) laboratories responded to the questionnaire survey; 24 of them reported routinely testing requested stool specimens for C. difficile. Main laboratory methods included toxin detection (21/24; 88%) and/or anaerobic culture (19/24; 79%). In June 2006, 18 (86%) of the 21 laboratories detecting toxins directly from feces, from the isolate, or both used methods for both toxin A (TcdA) and B (TcdB), whereas only one laboratory did so in 1996. By September 2008, all of the 23 laboratories performing diagnostics for C. difficile used methods for both TcdA and TcdB. In 2006, the number of specimens processed per 100,000 population varied remarkably between different hospital districts. In conclusion, culturing C. difficile is common and there has been a favorable shift in toxin detection practice in Finnish clinical microbiology laboratories. However, the variability in diagnostic activity reported in 2006 creates a challenge for national monitoring of the epidemiology of C. difficile and related diseases.