August 01, 2019
1 min read

CDI incidence rising in veterans under age 65, VA data show

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The incidence of Clostridioides difficile infection, or CDI, among veterans younger than 65 years old in the United States has been “steadily” rising in recent years, and nearly half of all new cases in this cohort are community-associated infections, according to Veterans Health Administration records.

“Our findings indicate that CDI incidence, driven primarily by community-associated infection, is rising among the veteran population aged 18 to 64 years with high service-related disability,” Ellyn M. Russo, MS, of the clinical epidemiology program at the Veterans Affairs Medical Center in White River, Vermont, and colleagues wrote. “The increasing burden of community-associated CDI in this vulnerable population warrants attention.”

According to Russo and colleagues, past research has elucidated risk factors for CDI in older patients, but there are limited data on the burden of CDI in those younger than 65 years of age, especially within the Veterans Health Administration (VHA).

In a 6-year retrospective cohort study, Russo and colleagues analyzed electronic health records data from VHA patients who were 18 to 64 years of age on Jan. 1, 2011, following them until incident CDI, death, loss to follow-up or Dec. 31, 2016. They used 2017 Society for Healthcare Epidemiology-Infectious Diseases Society of America guidelines to classify the setting of CDI onset.

In total, 1,073,900 patients were included and 10,534 had a CDI during follow-up. According to the study, the overall incidence rate was 177 CDIs per 100,000 person years, “rising steadily” from 164 in 2011 to 189 in 2016.

Russo and colleagues reported that patients with a CDI were slightly older (55 vs. 51 years old) and sicker, with a higher baseline Charlson comorbidity index score than those without an infection, 1.4 vs. 0.5. They found that the proportion of CDIs that was community-associated rose from 41% in 2011 to 56% in 2016, and was 48% during the length of the study.

“Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies,” they wrote. – by Caitlyn Stulpin

Disclosures: Russo reports receiving research funding from Pfizer. Please see the study for all other authors’ relevant financial disclosures.