Epidemiology of community-acquired and recurrent Clostridioides difficile infection

Abstract

Clostridioides difficile infection is a leading cause of healthcare-associated infections with significant morbidity and mortality. For the past decade, the bulk of infection prevention and epidemiologic surveillance efforts have been directed toward mitigating hospital-acquired C. difficile. However, the incidence of community-associated infection is on the rise. Patients with community-associated C. difficile tend to be younger and have lower mortality rate. Rates of recurrent C. difficile infection overall have decreased in the United States, but future research and public health endeavors are needed to standardize and improve disease detection, stratify risk factors in large-scale population studies, and to identify regional and local variations in strain types, reservoirs and transmission routes to help characterize and combat the changing epidemiology of C. difficile.

Wolf in Sheep’s Clothing: Clostridioides difficile Biofilm as a Reservoir for Recurrent Infections

“…This bacterium is an opportunistic pathogen that causes infection, with symptoms ranging from mild diarrhea to pseudomembranous colitis. C. difficile infections (CDI) are estimated to cause more than 450,000 infections per year in the United States of America (USA), with an annual cost to the health system of approximately $4.8 billion [ 166 , 167 ]. The more severe cases of CDI can be life-threatening, as the 30-day mortality rate is as high as 21% of diagnosed patients, which results in 15,000 to 30,000 deaths annually in the USA [ 168 ].…”

“…Moreover, several risk factors are associated with CDI including antibiotic therapy and hospitalizations as well as age (≥ 65 years) [ 170 ]. Thus, C. difficile is the most common cause of nosocomial diarrhea [ 171 ], and healthcare associated CDI cases represent more than half of all cases [ 166 ].…”

Clostridioides difficile infection: curbing a difficult menace

“…Clinical and epidemiological studies demonstrate a migration of CDI from being a hospital illness to also being a community illness. 2 Fu et al 3 describe the epidemiology of community-acquired and recurrent CDI. The incidence of community-acquired CDI has been increasing with antibiotics being a common risk factor and several patients developing community-acquired CDI without antibiotic exposure suggesting other risk factors in the community such as proton pump inhibitor use, conditions such as inflammatory bowel disease (IBD), and an aging population with comorbidities.…”

“…In addition, the rates of recurrent infection continue to be high with a trend toward a decrease in the last decade likely owing to advances in treatment modalities. 3 Most recurrences happen within 8 weeks and delayed recurrences can be seen. The actual impact of the COVID-19 pandemic on the incidence of CDI needs to be completely determined with larger population-based studies.…”

“…The actual impact of the COVID-19 pandemic on the incidence of CDI needs to be completely determined with larger population-based studies. 3 Gupta et al outline the economic burden of CDI suggesting that CDI adds from 3 to 20 days to a hospitalization with an additional cost of over five billion dollars annually in the United States and similar high expenses worldwide.…”