Changing Epidemiology of 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 healthcare 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 20-28% of CDI is community associated.
    • Contact with children less than 2 years of age has been associated with community-associated CDI.
  • CDI remains a mostly healthcare associated disease.
    Although community-associated patients have not been hospitalized, a majority have had other recent healthcare exposures (such as dental office visits, outpatient clinics visits, and in outpatient surgical centers).

Updated Friday, 10-Jan-2014 14:06:05 CST