Clostridioides difficile Infection (CDI) Surveillance

Purpose

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.

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 latest data from all EIP sites is summarized by the CDC EIP. View the latest data from Monroe County.

Selected Publications

• Guh AY, MuY, Winston LG, Johnston H, Olson D, Farley MM, Wilson LE, Holzbauer SM, Phipps EC, Dumyati G, et al. for the Emerging Infections Program Clostridioides difficile Infection Working Group. Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes. N Engl J Med 2020; 382:1320-1330. 2020, April 2. DOI: 10.1056/NEJMoa1910215. 

• Guh AY, Hatfield KM, Winston LG, Martin B, Johnston H, Brousseau G, Farley MM, Wilson L, Perlmutter R, Phipps EC, Dumyati GK, Nelson D, Hatwar T, Kainer MA, Paulick AL, Karlsson M, Gerding DN, McDonald LC. Enzyme Immunoassays Detect Clostridioides difficile Infection with Greater Severity and Higher Recurrence Rates. Clin. Infect. Dis. 2019, Jan. 7. doi: 10.1093/cid/ciz009.  

• Guh AY, Mu Y, Baggs J, Winston LG, Bamberg W, Lyons C, Farley MM, Wilson LE, Holzbauer SM, Phipps EC, Beldavs ZG, Kainer MA, Karlsson M, Gerding DN, Dumyati G. Trends in incidence of long-term-care-facility-onset Clostridium difficile infections in 10 US geographic locations during 2011-2015.  Am J Infect Control. 2018.

• Tsay S, Williams SR, Benedict K, Beldavs Z, Farley M, Harrison L, Schaffner W, Dumyati G, Blackstock A, Guh A, Vallabhaneni S. A Tale of Two Healthcare-Associated Infections: Clostridium difficile Coinfection Among Patients with Candidemia. Clin. Infect. Dis. 2018 Jul 27. doi: 10.1093/cid/ciy607.

• Guh AY, Adkins SH, Li Q, Bulens SN, Farley MM, Smith Z, Holzbauer SM, Whitten T, Phipps EC, Hancock EB, Dumyati G, Concannon C, Kainer MA, Rue B, Lyons C, Olson DM, Wilson L, Perlmutter R, Winston LG, Parker E, Bamberg W, Beldavs ZG, Ocampo V, Karlsson M, Gerding DN, McDonald LC. Risk Factors for Community Associated Clostridium difficile Infection in Adults: A Case-Control Study. Open Forum Infect Dis. 2017 Oct 26;4(4):ofx171. doi: 10.1093/ofid/ofx171. eCollection 2017 Fall. 

• Hunter JC, Mu Y, Dumyati GK, Farley MM, Winston LG, Johnston HL, Meek JI, Perlmutter R, Holzbauer SM, Beldavs ZG, Phipps EC, Dunn JR, Cohen JA, Avillan J, Stone ND, Gerding DN, McDonald LC, Lessa FC. Burden of nursing home-onset Clostridium difficile infection in the United States: estimates of incidence and patient outcomes. Open Forum Infect Dis. 2016;3(1): ofv196.
• Baggs J, Yousey-Hindes K, Ashley ED, Meek J, Dumyati G, Cohen J, Wise M, Clifford McDonald L, Lessa FC. Identification of population at risk for future Clostridium difficile infection following hospital discharge to be targeted for vaccine trials. Vaccine. 2015 Oct 5; Epub 2015 Oct 05.
• Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, Farley MM, Holzbauer SM, Meek JI, Phipps EC, Wilson LE, Winston LG, Cohen JA, Limbago BM, Fridkin SK, Gerding DN, McDonald LC. Burden of Clostridium difficile in the United States. The New England Journal of Medicine. 2015 Feb 26; 372(9):825-34.
• Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C, Farley MM, Dumyati GK, Wilson LE, Beldavs ZG, Dunn JR, Gould LH, MacCannell DR, Gerding DN, McDonald LC, Lessa FC. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013 Jul 22;173(14):1359-67. doi: 10.1001/jamainternmed.2013.7056.

Related Links

• Video Summary: Amit S. Chitnis, MD, MPH, discusses Epidemiology of Community-Associated Clostridium difficile Infection, 2009 Through 2011.
• CDC: Stopping C. difficile Infections