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).