2014 Annual Report for the Emerging Infections Program for Clostridium difficile Infection

2014 Annual Report Print Version Cdc-pdf[PDF – 5.52 MB]

In 2014, a total of 16,333 cases of C. difficile infection (CDI) were reported to the Emerging Infections Program (EIP) in 35 counties in 10 US states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee).

The overall distribution of EIP CDI cases and crude incidence by selected demographic factors and epidemiologic classification are presented in Table 1. Data in this report are not intended to be directly compared to annual reports from other years, and should not be used to determine annual changes in EIP CDI incidence rates because single year calculations do not account for changes in testing practices by reporting facilities.

Table 1. Reported Number of CDI Cases and Crude Incidence by Sex, Age Group, Race, and Epidemiologic Classification Among the 10 EIP Sitesa

Reported Number of CDI Cases and Crude Incidence by Sex, Age Group, Race, and Epidemiologic Classification Among the 10 EIP Sites
Demographic Characteristic Population ≥1 Year of Age Community Associated CDIb
Number
Community Associated CDIb
Incidence per 100,000 persons
Healthcare Associated CDIb
Number
Healthcare Associated CDIb
Incidence per 100,000 persons
All CDI
Number
All CDI
Incidence per 100,000 persons
Male 5647311 2487 44.04 4220 74.73 6707 118.76
Female 5886545 4183 71.06 5443 92.47 9626 163.53
1-17 years 2525154 580 22.97 192 7.60 772 30.57
18-44 years 4538522 1632 35.96 1054 23.22 2686 59.18
45-64 years 3025422 2060 68.09 2682 88.65 4742 156.74
≥65 years 1444758 2398 165.98 5735 396.95 8133 562.93
White 7927252 5239 66.09 7255 91.52 12494 157.61
Non-white 3606604 1431 39.68 2408 66.77 3839 106.44
Total 11533856 6670 57.83 9663 83.78 16333 141.61

 

  1. The epidemiologic classification was statistically imputed for 0.4% of the observed CDI cases, and race was statistically imputed for 18.8% of the observed CDI cases. The weighted frequency of cases in Colorado and Georgia was based on 33% random sampling.
  2. A CDI case was classified as community-associated if the C. difficile-positive stool specimen was collected on an outpatient basis or within 3 days after hospital admission in a person with no documented overnight stay in a healthcare facility in the preceding 12 weeks. All CDI cases that do not meet the aforementioned criteria were classified as healthcare-associated.

Laboratory Characterization of C. difficile Isolates

In 2014, a total of 1,122 C. difficile isolates were submitted to CDC for further analysis. The total number of isolates received from each site ranged from 13 to 251, with a median of 102. The majority of the isolates (89%) were collected in metropolitan areas.

Among all isolates submitted, 135 distinct ribotypes were detected. Ribotype 106 was the most common ribotype among community-associated C. difficile isolates, followed by 002, 020 and 027 (Table 2). Among healthcare-associated C. difficile isolates, ribotype 027 predominated, followed by 106, 002 and 014. (Table 3). A significant decrease in ribotype 027 occurred from 12% in 2013 to 7% in 2014 among community-associated C.difficile isolates. Similarly, ribotype 027 decreased from 24% in 2013 to 14% among healthcare-associated isolates of C. difficile.

Twenty-two percent of the isolates harbored a deletion in tcdC. Twenty-two percent of the isolates were binary toxin-positive, and among these, ribotypes 027, 078 and 019 predominated.

Table 2. Frequency of Ribotypes Among Community-Associated C. difficile Isolates, 2014 (n=618)

Frequency of Ribotypes Among Community-Associated C. difficile Isolates, 2014 (n=618)
Ribotype No of isolates % isolates
 106 70 11%
002 49 8%
020 48 8%
027 44 7%
014 32 5%
054 25 4%
015 20 3%
076 20 3%
078 18 3%
005 17 3%
Others 275 44%

Table 3. Frequency of Ribotypes Among Healthcare-Associated C. difficile Isolates, 2014 (n=504)

Frequency of Ribotypes Among Healthcare-Associated C. difficile Isolates, 2014 (n=504)
Ribotype No of isolates % isolates
027 70 14%
106 61 12%
002 46 9%
014 35 7%
020 31 6%
056 18 4%
001_072 15 3%
 103 11 2%
054 10 2%
017 10 2%
Others 197 39%