2018 Annual Report for the Emerging Infections Program for Clostridioides difficile Infection

2018 Annual Report Print Version pdf icon[PDF – 2 pages]

In 2018, a total of 15,591 cases of C. difficile infection (CDI) were reported to the Emerging Infections Program (EIP) in 35 counties in 10 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 is 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
Table 2 Ribotype and Isolates
Sex Population ≥1 Year of Age Community Associated CDIb
No.
Community Associated CDIb
Incidenced
Healthcare Associated CDIb
No.
Healthcare Associated CDIb
Incidenced
All
CDIc
No.
All
CDIc
Incidenced
Male 5,866,907 2905 49.52 3640 62.04 6545 111.56
Female 6,116,019 4995 81.68 4051 66.23 9046 147.91
Table 2 Ribotype and Isolates
Age Group Population ≥1 Year of Age Community Associated CDIb
No.
Community Associated CDIb
Incidenced
Healthcare Associated CDIb
No.
Healthcare Associated CDIb
Incidenced
All
CDIc
No.
All
CDIc
Incidenced
1-17 years 2,526,903 675 26.70 228 9.03 903 35.74
18-44 years 4,691,190 1951 41.59 836 17.82 2787 59.41
45-64 years 3,088,096 2443 79.11 2227 72.12 4670 151.23
≥65 years 1,676,737 2832 168.91 4399 262.35 7231 431.25
Table 2 Ribotype and Isolates
Race Population ≥1 Year of Age Community Associated CDIb
No.
Community Associated CDIb
Incidenced
Healthcare Associated CDIb
No.
Healthcare Associated CDIb
Incidenced
All
CDIc
No.
All
CDIc
Incidenced
White 8,053,029 6330 78.60 5600 69.54 11930 148.14
Other 3,929,897 1571 39.98 2090 53.18 3661 93.16
Totalc 11,982,926 7901 65.93 7690 64.18 15591 130.11
  1. The epidemiologic classification was statistically imputed for 1.5% of the observed CDI cases, and race was statistically imputed for 18.7% 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.
  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.
  3. Subcategories may not add to total due to rounding.
  4. Cases per 100,000 persons.
Diagnostic testing

In 2018, 85% of participating laboratories reported routinely using a nucleic acid amplification test (NAAT) either alone or as part of a multistep testing algorithm for CDI diagnosis. Among all CDI cases identified in 2018, 21% were positive by a toxin enzyme immunoassay (EIA), 21% were positive by NAAT only (toxin-negative), 55% were positive by NAAT but no information was available regarding toxin-positivity (e.g., diagnosed by a laboratory that only utilized NAAT), and 3% were diagnosed by other methods (e.g., cell cytotoxicity assay).

Laboratory Characterization of C. difficile Isolates

This section will be updated once the data are available.

Appendix*

An initial chart review was performed on all CDI cases in eight EIP sites and on a random sample of cases in the two remaining EIP sites with the largest surveillance catchment areas (CO and GA).1 A subsequent comprehensive chart review was performed on all community-associated cases and a subset of healthcare-associated cases. Of 7418 cases with data available, 7091 (95.6%) received CDI treatment. These included 4798 (67.7%) cases treated with vancomycin (excluding vancomycin tapers), 366 (5.2%) with vancomycin tapers, 3268 (46.1%) with metronidazole, and 188 (2.7%) with fidaxomicin. Bezlotoxumab was administered to 7 cases. Overall, the average duration of therapy was 14 days (range: 1–104 days).

Of the 7091 treated cases, 3334 (47.0%) either required hospitalization for their CDI or were already hospitalized at the time of their CDI diagnosis. The average length of hospital stay was 8 days (range: 0–365 days). Among 3126 hospitalized cases with treatment dates available: 2664 (85.2%) were treated with vancomycin (excluding vancomycin taper), and on average, received 49.5% (range: 0% to 100%) of their therapy as inpatient and 50.5% (range: 0% to 100%) as outpatient; 1443 (46.2%) were treated with metronidazole, and on average, received 76.2 % (range: 0% to 100%) of their therapy as inpatient and 23.8% (range: 0% to 100%) as outpatient; and 72 (2.3%) were treated with fidaxomicin, and on average, received 61.7% (range: 0% to 100%) of their therapy as inpatient, and 38.4% (range: 0% to 100%) as outpatient.

References

1 Centers for Disease Control and Prevention. Healthcare-Associated Infections – Community Interface (HAIC). Clostridioides difficile infection (CDI) tracking. Available at: https://www.cdc.gov/hai/eip/cdiff-tracking.html Accessed November 17, 2020.

* The appendix Includes results of special analyses that are requested or of interest during a particular surveillance year.

Note: Data in this report were generated on March 17, 2020.