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{{Clostridium difficile}}
{{Siren|Clostridium difficile infection}}
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{{Clostridium difficile infection}}
{{CMG}}; {{AE}} {{YD}}
==Overview==
The incidence of ''C. difficile'' infection is estimated to be 140 per 100,000 individuals. In USA, the majority (65%) of cases are associated with healthcare settings, and 25% of cases are associated with previous hospitalizations. Although patients of all age groups may develop ''C. difficile'' infection, elderly patients > 65 years may have up to eight-fold increased risk of developing ''C. difficile'' infection compared with younger patients. Whites and female patients are more predisposed to develop ''C. difficile'' infections. Although ''C. difficile'' is abundantly reported in Europe and the United States, the infection is a global burden.


==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Incidence===
*The incidence of ''C. difficile'' infection is estimated to be 140 per 100,000 individuals and approximately 1,500 per 100,000 hospital discharges.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>
In the U.S. [[Veterans Affairs]] system, approximately 0.5% of admissions have c diff<ref name="pmid26864803">{{cite journal| author=Evans ME, Kralovic SM, Simbartl LA, Jain R, Roselle GA| title=Effect of a Clostridium difficile Infection Prevention Initiative in Veterans Affairs Acute Care Facilities. | journal=Infect Control Hosp Epidemiol | year= 2016 | volume= 37 | issue= 6 | pages= 720-2 | pmid=26864803 | doi=10.1017/ice.2016.27 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26864803  }} </ref><ref name="pmid31708000">{{cite journal| author=Sumon ZE, Lesse AJ, Sellick JA, Tetewsky S, Mergenhagen KA| title=Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting. | journal=Infect Control Hosp Epidemiol | year= 2020 | volume= 41 | issue= 1 | pages= 44-51 | pmid=31708000 | doi=10.1017/ice.2019.281 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31708000  }} </ref>.
===Age===
===Age===
*Patients of all age groups may develop ''C. difficile'' infection.
*Elderly patients > 65 years may have up to eight-fold increased risk of developing ''C. difficile'' infection compared with younger patients.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>
===Gender===
===Gender===
*There is a slight female predisposition to the development of ''C. difficile'' infection with a female to male ratio of 1.26.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>
===Race===
===Race===
*Caucasian individuals are more likely to develop ''C. difficile'' infection.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>
===Developed Countries===
===Developed Countries===
===Developing Countries===
* The estimated number of incident ''C. difficile'' infection in USA is estimated to be approximately range between approximately 397,000 and 508,500.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>


===Outbreaks===
* In USA, the majority (65%) of cases are associated with healthcare settings, and 25% of cases are associated with previous hospitalizations.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>


On June 4, 2004, two outbreaks of a highly virulent strain of this bacterium were reported in Montreal, Quebec and Calgary, Alberta, in Canada. Sources put the death count as low as 36 and as high as 89, with approximately 1,400 cases in 2003 and within the first few months of 2004. ''C. difficile'' infections continued to be a problem in the Quebec health care system in late 2004. As of March 2005, it had spread into the Toronto, Ontario area, hospitalizing 10 people. One died while the others were being discharged.
* In USA, the NAP1 ''C. difficile'' strain is more common in healthcare settings than in community settings.
* In 2011, approximately 29,000 deaths have been attributed to ''C. difficile'' infection in USA.<ref name="pmid25714160">{{cite journal| author=Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR et al.| title=Burden of Clostridium difficile infection in the United States. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 9 | pages= 825-34 | pmid=25714160 | doi=10.1056/NEJMoa1408913 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25714160  }} </ref>
* Several ''C. difficile'' outbreaks have been reported in Canada, USA, and Europe.


A similar outbreak took place at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005. The local [[epidemiology]] of ''C. difficile'' may offer clues on how its spread may relate to the amount of time a patient spends in hospital and/or a rehabilitation center. It also samples institutions' ability to detect increased rates, and their capacity to respond with more aggressive hand washing campaigns, quarantine methods, and availability of yoghurt to patients at risk for infection.
===Developing Countries===
 
*Although ''C. difficile'' is abundantly reported in Europe and the United States, the infection is a global burden.
It has been suggested that both the Canadian and English outbreaks were related to the seemingly more virulent 027 strain of bacterium. This strain has also been implicated in an epidemic at two Dutch hospitals (Harderwijk and Amersfoort, both 2005). A theory for explaining the increased virulence of 027 is that it is a hyperproducer of both toxin A and B, and that certain antibiotics may actually stimulate the bacteria to hyperproduce.
*The burden of ''C. difficile'' in developing countries is difficult to estimate due to scarcity of available data.
 
On December 2, 2005, The New England Journal of Medicine, in an article spearheaded by Drs. Vivian Loo, Louise Poirier, and Mark Miller, reported the emergence of a new, highly toxic strain of  ''C. difficile'', resistant to [[fluoroquinolone]] antibiotics, such as [[Cipro]] (ciprofloxacin) and [[Levaquin]] (levofloxacin), said to be causing geographically dispersed outbreaks in North America.<ref name=Loo_2005>{{cite journal |author=Loo V, Poirier L, Miller M, Oughton M, Libman M, Michaud S, Bourgault A, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson T, Horn R, René P, Monczak Y, Dascal A |title=A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality |journal=N Engl J Med |volume=353 |issue=23 |pages=2442-9 |year=2005 |pmid=16322602}}</ref> The [[Centers for Disease Control]] in Atlanta has also warned of the emergence of an epidemic strain with increased virulence, antibiotic resistance, or both.<ref name=McDonald_2005>{{cite journal |author=McDonald L |title=''Clostridium difficile'': responding to a new threat from an old enemy |journal=Infect Control Hosp Epidemiol |volume=26 |issue=8 |pages=672-5 |year=2005 |url= http://www.cdc.gov/ncidod/dhqp/pdf/infDis/Cdiff_ICHE08_05.pdf | pmid=16156321}}</ref>
 
As one analyzes the pool of patients with the spores, many who are asymptomatic will pass the organism to individuals who are immunocompromised and hence, susceptible to increasing rates of diarrhea and poor outcome. It seems notable that the clusters described above represent a challenge to epidemiologists trying to understand how the illness spreads via the convergence of information technology with clinical surveillance.
 
On October 1, 2006, the bacteria was said to have killed at least 49 people at hospitals in Leicester, England over eight months, according to a National Health Service investigation. Another 29 similar cases were investigated by [[coroner]]s.<ref>[http://news.bbc.co.uk/1/hi/england/leicestershire/5396800.stm Trust confirms 49 superbug deaths] - [[BBC News]]</ref> An UK Department of Health memo leaked shortly afterwards revealed significant concern in government about the bacterium, described as being "endemic throughout the health service"<ref>{{cite web| url= http://www.timesonline.co.uk/article/0,,2-2541472,00.html| title=Leaked memo reveals that targets to beat MRSA will not be met| author=Nigel Hawkes| date=11th January 2007| work=The Times| accessdate = 2007-01-11}}</ref>
 
On October 27, 2006, the bacteria was attributed to 9 deaths in Quebec, Canada.<ref>{{cite web| url= http://cnews.canoe.ca/CNEWS/Canada/2006/10/27/2145519.html| title=C. difficile blamed for 9 death in hospital near Montreal| date=11th January 200| work=cNews| accessdate = 2007-01-11}}</ref>
 
On November 18th, 2006, the bacteria was reported to have been responsible for 12 deaths in Quebec, Canada. This 12th reported death was only two days after the St. Hyacinthe's Honoré Mercier announced that the outbreak was under control. 31 patients were diagnosed with Clostridium difficile and four (as of Sat. Nov 18th) were still under observation. Cleaning crews took measures in an attempt to clear the outbreak.<ref>[http://www.cbc.ca/canada/story/2006/11/18/difficile-outbreak.html 12th person dies of C. difficile at Quebec hospital] - [[CBC News]]</ref>
 
On February 27, 2007, a new outbreak was identified at Trillium Health Centre in Mississauga Ontario, where 14 people were diagnosed with the bacteria. The bacteria was the same strain as the one in Quebec. Officials have not been able to determine if C. difficile was responsible for deaths of four patients over the prior two months.<ref>[http://toronto.ctv.ca/servlet/an/local/CTVNews/20070228/cdifficile_mississauga_outbreak_070228/20070228/?hub=TorontoHome]</ref>
 
In October 2007, Maidstone and Tunbridge Wells NHS Trust was heavily criticized by the Healthcare Commission regarding its handling of a major outbreak of ''C. difficile'' in its hospitals in Kent from April 2004 to September 2006. In its report, the Commission estimated that about 90 patients "definitely or probably" died as a result of the infection. <ref>Healthcare Commission press release: [http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm/cit_id/5875/FAArea1/customWidgets.content_view_1/usecache/false Healthcare watchdog finds significant failings in infection control at Maidstone and Tunbridge Wells NHS Trust], 11 October 2007</ref><ref>Daily Telegraph, [http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/10/11/ncdiff611.xml  Health Secretary intervenes in superbug row], 11 October 2007</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Disease]]
[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Infectious disease]]
 
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]

Latest revision as of 02:29, 13 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.

Overview

The incidence of C. difficile infection is estimated to be 140 per 100,000 individuals. In USA, the majority (65%) of cases are associated with healthcare settings, and 25% of cases are associated with previous hospitalizations. Although patients of all age groups may develop C. difficile infection, elderly patients > 65 years may have up to eight-fold increased risk of developing C. difficile infection compared with younger patients. Whites and female patients are more predisposed to develop C. difficile infections. Although C. difficile is abundantly reported in Europe and the United States, the infection is a global burden.

Epidemiology and Demographics

Incidence

  • The incidence of C. difficile infection is estimated to be 140 per 100,000 individuals and approximately 1,500 per 100,000 hospital discharges.[1]

In the U.S. Veterans Affairs system, approximately 0.5% of admissions have c diff[2][3].

Age

  • Patients of all age groups may develop C. difficile infection.
  • Elderly patients > 65 years may have up to eight-fold increased risk of developing C. difficile infection compared with younger patients.[1]

Gender

  • There is a slight female predisposition to the development of C. difficile infection with a female to male ratio of 1.26.[1]

Race

  • Caucasian individuals are more likely to develop C. difficile infection.[1]

Developed Countries

  • The estimated number of incident C. difficile infection in USA is estimated to be approximately range between approximately 397,000 and 508,500.[1]
  • In USA, the majority (65%) of cases are associated with healthcare settings, and 25% of cases are associated with previous hospitalizations.[1]
  • In USA, the NAP1 C. difficile strain is more common in healthcare settings than in community settings.
  • In 2011, approximately 29,000 deaths have been attributed to C. difficile infection in USA.[1]
  • Several C. difficile outbreaks have been reported in Canada, USA, and Europe.

Developing Countries

  • Although C. difficile is abundantly reported in Europe and the United States, the infection is a global burden.
  • The burden of C. difficile in developing countries is difficult to estimate due to scarcity of available data.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR; et al. (2015). "Burden of Clostridium difficile infection in the United States". N Engl J Med. 372 (9): 825–34. doi:10.1056/NEJMoa1408913. PMID 25714160.
  2. ↑ Evans ME, Kralovic SM, Simbartl LA, Jain R, Roselle GA (2016). "Effect of a Clostridium difficile Infection Prevention Initiative in Veterans Affairs Acute Care Facilities". Infect Control Hosp Epidemiol. 37 (6): 720–2. doi:10.1017/ice.2016.27. PMID 26864803.
  3. ↑ Sumon ZE, Lesse AJ, Sellick JA, Tetewsky S, Mergenhagen KA (2020). "Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting". Infect Control Hosp Epidemiol. 41 (1): 44–51. doi:10.1017/ice.2019.281. PMID 31708000.
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