Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015–2019

Abstract

C lostridioides difficile is a major cause of infectious nosocomial diarrhea in high-income countries (1). Disease severity ranges from asymptomatic colonization to fulminant colitis, sometimes leading to colectomy and death (2). Healthcare costs attributed to C. difficile infection (CDI) are estimated to be $4.8 billion in the United States and €3 billion in Europe (3). A study in Canada estimated 38,000 annual CDI cases and conservative estimated costs of CDN $280 million resulting from extended hospital stays and rehospitalization (4).The epidemiology of C. difficile has evolved markedly in the past decade (1). Whereas CDI was once Characterization of Healthcare-Associated and Community-Associated Clostridioides difficileInfections among Adults,

Review article: The epidemiology and management of Clostridioides difficile infection—A clinical update

“…6,16 Canadian estimates showed an increase in ribotype 106 from 7.3% in 2015 to 18.9% in 2019. 13 Similar trends were observed in Europe based on 2016-2017 surveillance data, with a decline in ribotype 027 and the most frequent ribotype observed was 014/020. 19 In Australia, recent data between 2013 and 2018 showed ribotype 014/020 is also the most frequent strain detected.…”

“…13 The estimated hospital-associated CDI rates in Canada decreased from 4.74 to 3.61 cases per 10,000 patient days during this period. 13 In contrast, the average annual rate of hospital-associated CDI in Australia has increased from 3.94 to 4.05 per 10,000 patient bed days between 2013 and 2018. 14 Among Asian countries, a systematic review and meta-analysis found an overall incidence in Asia that was similar to Western nations, with approximately 5.3 CDI cases per 10,000 patient days.…”

“…A second study including 20 European countries between 2011 and 2013 showed a mean incidence of seven cases per 10,000 patient days (range 0.7–28.7) 12 . The Canadian Nosocomial Infection Surveillance Program, a multicenter hospital‐based epidemiologic study, evaluated updated CDI surveillance between 2015 and 2019 and demonstrated a decrease in both adult community and hospital associated CDI by 24% and 19%, respectively 13 . The estimated hospital‐associated CDI rates in Canada decreased from 4.74 to 3.61 cases per 10,000 patient days during this period 13 .…”

Trends in Clostridioides difficile infection rates in Canadian hospitals during the coronavirus disease 2019 (COVID-19) pandemic

“…Our previous surveillance data showed a steady decline in CDI rates before the pandemic. 7,8 However, during the pandemic, we observed an increase in HA- and CA-CDI rates, whereas other jurisdictions reported varying changes in healthcare-associated infections. 9 CDI and COVID-19 coinfection was uncommon (5%); however, COVID-19 patients were more likely to be associated with HA-CDI acquisition than non–COVID-19 patients.…”

Retrospective Cohort Analysis of Outpatient Antibiotic Use for Clostridioides difficile-Indicated Agents in British Columbia, from 2000 to 2018

“…Clostridioides difcile (formerly Clostridium difcile) is the most common cause of hospital-associated diarrheal infections [1]. Pathogenic strains produce toxin A, B, or a binary toxin upon colonization of the gut, which can lead to a range of symptoms from diarrhea, colitis, and in severe cases death [2]. Clostridioides difcile infection (CDI) has traditionally been characterized as nosocomial, or healthcare-associated (HA), with the incidence of HA-CDI being 2.1/10 000 to 6.5/10 000 inpatient days [3].…”