Epidemiology of Clostridium difficile Infection

Abstract

There has been dramatic change in the epidemiology of Clostridium difficile infection (CDI) since the turn of the 21st Century noted by a marked increase in incidence and severity, occurring at a disproportionately higher frequency in older patients. Historically considered a nosocomial infection associated with antibiotic exposure, CDI has now also emerged in the community in populations previously considered low risk. Emerging risk factors and disease recurrence represent continued challenges in the management of CDI. The increased incidence and severity associated with CDI has coincided with the emergence and rapid spread of a previously rare strain, ribotype 027. Recent data from the U.S. and Europe suggest the incidence of CDI may have reached a crescendo in recent years and is perhaps beginning to plateau. The acute-care direct costs of CDI were estimated to be $4.8 billion in 2008. However, nearly all the published studies have focused on CDI diagnosed and treated in acute-care hospital setting and fail to measure the burden outside the hospital, including recently discharged patients, outpatients, and those in long-term care facilities. Enhanced surveillance methods are needed to monitor the incidence, identify populations at risk, and characterize the molecular epidemiology of strains causing CDI.

Economics and financing of vaccines for diarrheal diseases

“…47 The incidence of C. difficile infection (CDI) has been on the rise, 48 more than doubling from 1991 to 2003 (from 65.6 to 156.6 per 100 000 population). 49 More than a 2.5-fold increase (139 000 to 349 000) in the number of hospitalizations with any CDI discharge diagnosis has been noted in the US from 2000 to 2008 (with a 3.5-fold increase for a primary diagnosis), while the number of CDI-related hospitalizations appears to have leveled off between 2008 and 2010. 49 Similar tends have been seen in Europe since 2007 and may be declining; a 61% reduction in the incidence was noted in England from 2007 to 2010.…”

“…49 More than a 2.5-fold increase (139 000 to 349 000) in the number of hospitalizations with any CDI discharge diagnosis has been noted in the US from 2000 to 2008 (with a 3.5-fold increase for a primary diagnosis), while the number of CDI-related hospitalizations appears to have leveled off between 2008 and 2010. 49 Similar tends have been seen in Europe since 2007 and may be declining; a 61% reduction in the incidence was noted in England from 2007 to 2010. 49 Of noticeable importance is the increased incidence of community-associated CDI in populations once considered to be low-risk; approximately 20% to 27% of all CDI cases are community-associated.…”

The Use of Probiotics in the Prevention of Clostridium Difficile Infection

“…difficile infection is the major identifiable cause of antibiotic-associated diarrhea and is responsible for 15-25 percent of all cases, with a marked increase in the incidence of CDI since the turn of the 21st century (Bartlett & Gerding, 2008). The reemergence of CDI, coupled with an increasingly vulnerable healthcare population, has resulted in more frequent medical and surgical complications, added health care costs, and greater mortality (DePestel & Aronoff, 2013). Hospitalized patients are considered to be especially high risk for CDI, and among inpatient cases, antibiotic treatment has been an almost universal factor in the development of CDIs (DePestel & Aronoff).…”

Identification of Factors Impacting Recurrent Clostridium difficile Infection and Development of a Risk Evaluation Tool

“…Factors shown to repeatedly correlate with RCDI were increasing age (≥ 65 years old), antibiotic therapy, and concomitant use of acid-suppressing medications (proton-pump inhibitors most frequently studied) (5)(6)(7)(12)(13)(14)(15)(16). While these factors were the most commonly cited, there are many other factors individually studied and found to be independently associated with CDI/RCDI including obesity, intraabdominal or gastrointestinal surgery, tube feedings or nasogastric tubes, inflammatory bowel disease (IBD), and immunocompromising disease states or medications (1,4,(17)(18)(19)(20)(21). The purpose of this study was to identify factors associated with RCDI and develop an evaluation tool to stratify the risk of developing recurrent infection.…”

“…Up to 40-65% of patients will have another episode of CDI when that time period is extended to several years in the presence of multiple risk factors such as repeated exposure to healthcare and broad spectrum antibiotics (1,(3)(4)(5)(6)(7). The majority of epidemiology literature defines recurrence as CDI within the first two months of the initial episode (4)(5)(7)(8).…”