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 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 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 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.