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URochester Medicine / Center for Community Health & Prevention / Surveillance & Prevention / Emerging Infections Program / CDI Surveillance

Clostridioides difficile Infection (CDI) Surveillance

Purpose

C. difficile organismsC. 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.

Methods

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 graph shows the incidence of C. difficile among individuals > 1 year of age in Monroe County from 2010-2025 with each line representing a different epidemiologic classification. Over the past 15 years, incidence of community-associated (CA) C. diff has increased and become predominant while sustained decreases among Longterm care-onset (LTCO), Hospital Onset (HO), and Community Onset Healthcare-associated (CO-HCFA) C. diff has been observed.

Selected Publications

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