April 07, 2020
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Decline in national C. difficile burden correlates with decrease in health care-associated cases

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The estimated national burden of Clostridioides difficile infections and related hospitalizations declined between 2011 and 2017 because of a decrease in health care-associated infections, according to findings published in the New England Journal of Medicine.

“It is important for the CDC to track the national progress in C. difficile infection (CDI) prevention efforts. Therefore, it is important to know the estimated national burden of CDI and how the burden estimates changed over time,” Alice Y. Guh, MD, MPH, medical officer in the CDC’s division of healthcare quality promotion and lead of the CDC’s C. difficile infection surveillance program, told Healio. “These estimates are important to public health officials and policymakers in prioritizing resources and guiding strategic planning for the prevention of health care-associated infections, including CDI. These estimates are also important to academic researchers and scientists working to advance the field of CDI research, as well as frontline providers and health care facilities actively engaged in CDI prevention collaboratives.”

Guh and colleagues found cases of C. difficile infection at 10 U.S. sites through the Emerging Infections Program. A case was defined as stool specimens that were positive for C. difficile in a person one year of age or older with no positive result in the preceding 8 weeks. The researchers used case and census sampling weights to calculate the national burden of C. difficile infection, first recurrences, hospitalizations and in-hospital deaths from 2011 through 2017. Health care-associated infections were classified as infections with onset in a health care facility or related to recent admission to a facility; all others were categorized as community-associated infections.

Guh and colleagues found that the number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011 (10,177 health care-associated and 5,284 community-associated cases) and 15,512 in 2017 (7,973 health care-associated and 7,539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% CI, 419,900-532,900) in 2011 and 462,100 cases (95% CI, 428,600-495,600) in 2017.

After accounting for the increased sensitivity of nucleic acid amplification tests, the estimate of the total C. difficile infection burden declined by 24% (95% CI, 6%-36%) from 2011 through 2017. According to the study, the adjusted estimate of the national burden of health care-associated C. difficile infection decreased by 36% (95% CI, 24%-54%) and the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. Adjusted estimate of C. difficile hospitalizations declined by 24% (95% CI, 0%-48%). The estimates for the burden related to first recurrences and in-hospital deaths did not change significantly.

“Although it is encouraging that health care-associated CDI decreased from 2011 to 2017, community-associated CDI has not decreased and contributed to nearly 50% of the CDI burden in 2017,” Guh said. “To sustain the decrease in health care-associated CDI and reduce community-associated CDI, we need to improve adherence to recommended infection prevention measures and implement diagnostic and antibiotic stewardship in both inpatient and outpatient settings.”– by Caitlyn Stulpin

Disclosure: Guh reports no relevant financial disclosures.