More on clostridium difficile-associated diarrhoea in Australia

To evaluate further the importance of Clostridium difficile as a cause of d iarrhoea in Australia, 165 hospital laboratories were surveyed about 1995 u sing a self-administered questionnaire. Only 91 (55%) laboratories responde d and only 39 of these (43%) had laboratory facilities to detect C, diffici le routinely, 13 (33%) on request only and 19 (49%) on request or in certai n situations. Culture was used by 26 laboratories (67%), 15 (36%) used tiss ue culture assays and 24 (62%) used commercially available toxin kits. C, d ifficile detection rates varied from <1 to 49 per 100 hospital beds. Isolat ion rates in some small hospitals (<100 beds) were surprisingly high (15 ca ses per 100 beds) indicating that C. difficile-associated diarrhoea is not just confined to large institutions. Hospital laboratories using culture an d tissue culture cytotoxin assays had higher detection rates than laborator ies relying only on toxin detection kits. Detection rates were correlated w ith antimicrobial usage figures for those hospitals which could provide usa ge data and with laboratories considered competent in detecting C. difficil e. The correlation between incidence of C. difficile-associated diarrhoea a nd third generation cephalosporin usage was 0.87, while for gentamicin this figure was 0.37. The importance of C. difficile as a nosocomial pathogen i s still generally underestimated in Australia. Significant diagnostic and f inancial benefits may follow improvements in detection techniques and restr ictions in third generation cephalosporin usage. (C) 1999 Academic Press.