Dataset Information

Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes.

ABSTRACT:

Background

Efforts to prevent Clostridioides difficile infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of C. difficile infection is unclear.

Methods

The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ?1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used case and census sampling weights to estimate the national burden of C. difficile infection, first recurrences, hospitalizations, and in-hospital deaths from 2011 through 2017. Health care-associated infections were defined as those with onset in a health care facility or associated with recent admission to a health care facility; all others were classified as community-associated infections. For trend analyses, we used weighted random-intercept models with negative binomial distribution and logistic-regression models to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types.

Results

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 5284 community-associated cases) and 15,512 in 2017 (7973 health care-associated and 7539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017. With accounting for NAAT use, the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of health care-associated C. difficile infection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly.

Conclusions

The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care-associated infections. (Funded by the Centers for Disease Control and Prevention.).

SUBMITTER: Guh AY

PROVIDER: S-EPMC7861882 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Trends in U.S. Burden of <i>Clostridioides difficile</i> Infection and Outcomes.

Guh Alice Y AY Mu Yi Y Winston Lisa G LG Johnston Helen H Olson Danyel D Farley Monica M MM Wilson Lucy E LE Holzbauer Stacy M SM Phipps Erin C EC Dumyati Ghinwa K GK Beldavs Zintars G ZG Kainer Marion A MA Karlsson Maria M Gerding Dale N DN McDonald L Clifford LC

The New England journal of medicine 20200401 14

<h4>Background</h4>Efforts to prevent <i>Clostridioides difficile</i> infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of <i>C. difficile</i> infection is unclear.<h4>Methods</h4>The Emerging Infections Program identified cases of <i>C. difficile</i> infection (stool specimens positive for <i>C. difficile</i> in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used ...[more]

PMID: 32242357

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