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Increasing incidence of Clostridium difficile infection, Australia, 2011-2012

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To the Editor: Slimings and colleagues suggest that strain typing of Clostridium difficile would give greater insight into the epidemiology of this infection in Australia,1 as it has in the United Kingdom,2 demonstrating less inhospital transmission than suspected in the past. We believe this to be the case.

In a 2-year study of symptomatic C. difficile infection at our 350-bed tertiary hospital,3 we identified 262 cases between October 2011 and October 2013. Of these, 150 (57%) were hospital-onset cases after 48 hours of admission. Ribotyping of 147 of these strains showed 44 different types. There appeared to be no secondary cases of diarrhoea from symptomatic patients in our hospital, where patients with C. difficile infection are isolated immediately after being identified.

We identified only one possible cluster of seven cases of ribotype QX076 on a rehabilitation ward between March and September 2013. This ward has only two rooms with ensuite toilet facilities, with most toilets being shared by four patients. When a toilet is flushed without the lid closed, aerosol production may lead to surface contamination within the toilet environment, increasing the risk of case-to-case transmission of C. difficile.4