Increasing Incidence of Community-Acquired Clostridium difficile Infections Among Hospitalized Patients

Abstract

Background. The incidence of Clostridium difficile infection (CDI) in US hospitals continues to increase. Better understanding of the epidemiology of hospitalized patients with CDI is needed to inform prevention efforts. Methods. Twenty-five hospitals participating in the Duke Infection Control Outreach Network (DICON) from 1 January 2011 through 31 December 2015 were included in the analysis. CDI events were categorized as healthcare facility associated (HCFA) or community-acquired (CA) according to NHSN HAI surveillance definitions. Characteristics of CDI case patients were compared between CDI event categories. Poisson regression was used to model annual trends in CDI incidence rates over time, adjusting for clustering by hospital and molecular test use. Results. A total of 11,844 CDI events occurred over 6,394,962 patient days. 6038 (51%) of all CDI cases were CA (Table). From 2011 to 2015, the adjusted annual incidence rate of CA-CDI increased from 0.46 to 0.89 cases per 1000 patient-days (IRR 1.92, 95% CI 1.56-2.37), whereas HCFA-CDI also increased but to a lesser extent (IRR 1.42, 95% CI 1.18-1.71; Figure). Conclusion. Half of hospitalized patients with CDI had community-acquired infections, and from 2011 to 2015, the incidence rate of CA-CDI nearly doubled. CDI prevention efforts should target this emerging population. (Table Presented).