Changing Epidemiology of Clostridioides (Clostridium) difficile and CDI

• Increased incidence and severity of CDI is resulting in:
  • Increased length of hospitalization
  • More people being discharged to long-term care facilities who previously resided at home
  • Increased health care costs
• These increases are associated with the detection of a new epidemic strain: B1/NAP1/027, toxinotype III.
  • This strain, historically uncommon, is now epidemic throughout the United States.
  • Features of this new strain include:
    • Increased resistance to fluoroquinolones (a type of antibiotic)
    • Presence of an extra toxin (binary toxin)
    • Increased production of toxins A and B
• Since 2005, CDI has been identified among previously low-risk populations (e.g. generally healthy community members and those without recent antibiotic history).
  • An estimated 50-65% of CDI is community associated.
    • In Minnesota, in 2017 63% and 2016 58% were CA-CDI.
  • Contact with children less than 2 years of age has been associated with community-associated CDI.
• CDI remains a mostly health care associated disease.
  Although community-associated patients have not been hospitalized, a majority have had other recent health care exposures (such as dental office visits, outpatient clinics visits, and in outpatient surgical centers).
  
  
• Epidemiology of Community-Associated Clostridium difficile Infection, 2009-2011,
  PubMed. Published in the Journal of the American Medical Association.