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Data were entered into Microsoft Access?2000, and SPSS?16.0 software was used for the statistical analysis. Mean and median values obtained for each hospital size were compared by use of the t-test and the Mann�CWhitney U-test (two-tailed), respectively. Pooled mean rates and proportions obtained for each hospital size were compared by use of the Fisher exact test (two-tailed). A p-value of 122 laboratories to participate in the study, and 118 (96.7%) accepted. The participating laboratories belonged to 63 hospitals with UNC2881 500�C1000 beds (medium-sized hospitals) (36.4%), and 12 hospitals with >1000 beds (large hospitals) (10.2%). The hospitals were homogeneously distributed throughout Spain, and had an overall catchment population of 34?032?876 selleck products inhabitants aged ��2?years (75.4% of the Spanish population aged ��2?years at the time) and 62?697 beds. On the day of the study, there were 8478 admissions from patients aged ��2?years and 52?134 occupied beds by patients aged >2 years.. A total of 988 unformed stool specimens from 897 patients were selected for the study. After reception in the reference laboratory, 181 specimens belonging to children aged were excluded, leaving a final study sample of 807 specimens from 730 patients (from now on, we will refer to these specimens). The features of specimens and patients are shown in Table?1. In the reference laboratory, C.?difficile was cultured in 63 of selleckchem the 807 (7.8%) specimens selected for the study. Moreover, the cytotoxicity assay detected toxigenic isolates in 45 specimens (positive specimens) (positivity rate, 5.6%) from 42 patients. The estimated rate of hospital-acquired CDI in Spain on the day of the study, based on episodes of CDI for patients hospitalized for at least 3?days diagnosed in the reference laboratory, and admissions and occupied hospital beds for patients aged ��2?years, was 2.4?cases per 1000?admissions or 3.8?cases per 10?000?patient-days (Table?2). Comparison of the diagnostic results from the participating laboratories with those obtained from the reference laboratory revealed that two of every three episodes went undiagnosed in the participating laboratories, owing to non-sensitive diagnostic tests (19.0%) or lack of clinical suspicion (47.6%). This lack of suspicion was greater for infected patients who were not hospitalized or had been hospitalized for