2017 Annual Report for the Emerging Infections Program for Clostridioides difficile Infection
In 2017, a total of 15,512 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.
|Demographic Characteristic||Population ≥1 Year of Age||Community Associated CDIb
|Community Associated CDIb
|Healthcare Associated CDIb
|Healthcare Associated CDIb
- The epidemiologic classification was statistically imputed for 1.7% of the observed CDI cases, and race was statistically imputed for 15.3% of the observed CDI cases. The weighted frequency of cases in Colorado and Georgia was based on 33% random sampling for cases aged ≥18 years.
- 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.
- Cases per 100,000 persons.
In 2017, a total of 1050 C. difficile isolates were submitted to CDC for further analysis. The total number of isolates received from each site ranged from 11 to 285, with a median of 85.5. The majority of the isolates (98%) were collected in metropolitan areas.
Among all isolates submitted, 143 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 decrease in ribotype 027 occurred from 9% in 2016 to 6% in 2017 among community-associated C. difficile isolates (p=0.07), whereas ribotype 027 remained relatively stable among healthcare-associated C. difficile isolates between 2016 (16%) and 2017 (15%). A significant overall decline in ribotype 027 has been observed since 2012 among both community-associated (17% vs. 6%; p<0.0001) and healthcare-associated (21% vs. 15%; p=0.02) isolates. Additionally, ribotype 076, which was observed in 8 EIP sites, increased from 2% in 2016 to 5% in 2017 (p=0.05) among healthcare-associated isolates and replaced ribotype 020 as one of the top 5 healthcareassociated isolates in 2017.
Twenty-three 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.
Note: Data in this report were generated on March 27, 2019.