Determining Mortality Rates Attributable toClostridium difficileInfection

To determine accuracy of measures of deaths attributable to Clostridium diffi cile infection, we compared 3 measures for 2007-2008 in Ontario, Canada: death certifi cate; death within 30 days of infection; and panel review.Data on death within 30 days were more feasible than panel review and more accurate than death certifi cate data.C lostridium diffi cile infection (CDI) has emerged as a major health care-associated infection; incidence, hospitalizations, and mortality rates are increasing (1,2).Reported case-fatality rates are 6%-30% and seem to be rising (3,4).The reporting of CDI-associated deaths could be considered a quality indicator; however, the accuracy of death certifi cate data is questionable (5).We analyzed CDI deaths in 3 hospitals in Ontario, Canada, and compared 3 measures for attributing death to CDI: death certifi cate, death within 30 days of CDI, and a panel review process (considered the reference standard).Use of trade names is for identifi cation only and does not imply endorsement by the Public Health Service or by the US Department of Health and Human Services.