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Clostridioides difficile Infection (CDI) Surveillance


C diff.C. difficile is a bacteria that causes diarrhea, and occasionally, severe infection, hospitalization, and death. The purpose of this surveillance in Monroe County is to monitor trends in C. difficile infection incidence and strain types in order to target prevention efforts.

Goals and Objectives

  • Determine the population-based incidence of community- and healthcare-associated CDI among participating EIP sites.
  • Characterize C. difficile strains that are responsible for CDI in the population under surveillance with a focus on strains from community-associated cases.
  • Describe the epidemiology of community- and healthcare-associated CDI and generate hypotheses for future research activities using EIP CDI surveillance infrastructure.


Cases of CDI are reviewed and classified into different epidemiological classes using the definitions below:

CDC CDI surveillance definitions:

Hospital-onset (HO): If positive stool specimen collected in a hospital setting more than 3 days after admission

Nursing home-onset (NHO): If positive stool specimen was collected at any time during the stay of a nursing home resident.

Community-associated (CA): If positive stool specimen was collected in an outpatient setting or within 3 calendar days in a person with no documented overnight stay in a healthcare facility during the 12 weeks before the specimen was collected. 

Community-onset healthcare facility-associated (CO-HCFA): If the positive stool specimen was collected in an outpatient setting or within 3 days after hospital admission in a person with documented overnight stay in a healthcare facility (i.e., history of hospitalization or long-term care facility residency in the 12 weeks before stool specimen collection)

Surveillance Report

The incidence of C. difficile infection by epidemiologic classification in Monroe County is shown below. Of note, all of the local microbiology laboratories implemented a nucleic acid amplification assay for diagnosis of C. difficile starting in 2011. The latest data from all EIP sites is summarized by the CDC EIP. View the latest data from Monroe County.

CDiff graph

Selected Publications

Related Links

Szymczak JE; Muller BM; Shakamuri NS; Hamilton KW; Gerber JS; Laguio-Vila M; Dumyati GK; Fridkin SK; Guh AY; Reddy SC; Lautenbach E;   Prescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and infection. Infection control and hospital epidemiology..2020;Epub 2020 May 29