Materiały źródłowe

• #1 The burden of CDI in the United States: a multifactorial challenge | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08096-0

  Clostridioides difficile infection (CDI) affects approximately 500,000 patients annually in the United States, of these around 30,000 will die. […] The Centers for Disease Control (CDC) identified CDI as an urgent threat, highlighting the need for immediate and aggressive action to prevent complications and recurrences of this infection. […] Despite some of the challenges of detecting C. difficile, the toxins produced, and the potential over-reporting based on PCR testing, CDI is associated with almost half a million infections and roughly 30,000 deaths annually in the US. […] The CDC reports that the incidence rate of healthcare-associated CDI (defined as those with onset in a healthcare facility or associated with recent admission to a healthcare facility) is 57.9 cases per 100,000 persons, which represents a sizeable decline in recent years.

• #2 Clostridioides difficile infection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431054/

  The data indicated that approximately half a million Americans are infected by C difficile infections annually. […] Among those infected, about 29,000 patients experienced fatal outcomes within a month of diagnosis, and 15,000 of these deaths were directly linked to C difficile infection. […] Moreover, approximately 83,000 patients experienced at least a recurrence of C difficile infection, and 29,000 of them succumbed within 30 days of the initial diagnosis. […] However, more recent data from the United States and Europe show a decreasing prevalence and trend of C difficile infections within healthcare systems, particularly notable in the prevalence of NAP1/B1/027 strain. […] This decrease may be attributed to a multifaceted approach to reduce unnecessary antimicrobial usage, implement antibiotic stewardship practices, and enhance infection control procedures. […] Nevertheless, heterogeneity in testing, surveillance, infection prevention, and control practices prevails among hospitals globally and between countries.

• #3 About C. diff | C. diff | CDC

  https://www.cdc.gov/c-diff/about/index.html

  C. diff is estimated to cause almost half a million infections in the United States each year. […] C. diff infection is more common among patients in healthcare settings, such as hospitals and nursing homes. This is because many people carrying C. diff stay or get treated in those facilities. […] CDC works with both federal and public health partners to reduce C. diff infections. […] C. diff infections are an urgent problem in hospitals, nursing homes, and in communities. CDC is involved in education, research, and tracking and reporting efforts to reduce C. diff infections.

• #4 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  There has been dramatic change in the epidemiology of Clostridium difficile infection (CDI) since the turn of the 21st Century noted by a marked increase in incidence and severity, occurring at a disproportionately higher frequency in older patients. […] Historically considered a nosocomial infection associated with antibiotic exposure, CDI has now also emerged in the community in populations previously considered low risk. […] Emerging risk factors and disease recurrence represent continued challenges in the management of CDI. […] The increased incidence and severity associated with CDI has coincided with the emergence and rapid spread of a previously rare strain, ribotype 027. […] Recent data from the U.S. and Europe suggest the incidence of CDI may have reached a crescendo in recent years and is perhaps beginning to plateau.

• #5 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  Enhanced surveillance methods are needed to monitor the incidence, identify populations at risk, and characterize the molecular epidemiology of strains causing CDI. […] Data from the U.S. and Europe suggest the incidence of CDI may have reached a crescendo in recent years and is leveling off or slightly declining. […] However, the overall incidence of CDI has increased to the point of surpassing rates of methicillin-resistant S. aureus infections in the some areas of the U.S. as the most common cause of healthcare-associated infection. […] Paralleling this increased prevalence there has also been a corresponding increase in morbidity and mortality associated with CDI, which has coincided with the emergence and rapid spread of a previously rare strain, known synonymously as polymerase chain reaction (PCR) ribotype 027, North American Pulse-field type 1 (NAP1), or restriction endonuclease analysis (REA) type BI, heretofore referred to as ribotype 027.

• #6 Clostridioides difficile infection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431054/

  Reviewing data from the early 2000s, a notable increase was seen in the incidence of C difficile infections and related hospitalizations, attributed to the emergence of the epidemic strain C difficile NAP1/B1/027. […] In a 2007 study by Hall et al, a C difficile infection emerged as the leading cause of gastroenteritis, correlating with a 5-fold increase in mortality. […] Furthermore, data from a 2011 article published by the Centers for Disease Control and Prevention and authored by Lessa et al demonstrated a rise in C difficile incidence across 10 geographic areas in the United States compared to the previous decade, with a higher occurrence observed among females and individuals aged 65 and older. […] This increase may have been associated with adopting newer, more sensitive C difficile assays, such as nucleic acid amplification tests (NAATs).

• #7 Clostridioides difficile infection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431054/

  The data indicated that approximately half a million Americans are infected by C difficile infections annually. […] Among those infected, about 29,000 patients experienced fatal outcomes within a month of diagnosis, and 15,000 of these deaths were directly linked to C difficile infection. […] Moreover, approximately 83,000 patients experienced at least a recurrence of C difficile infection, and 29,000 of them succumbed within 30 days of the initial diagnosis. […] However, more recent data from the United States and Europe show a decreasing prevalence and trend of C difficile infections within healthcare systems, particularly notable in the prevalence of NAP1/B1/027 strain. […] This decrease may be attributed to a multifaceted approach to reduce unnecessary antimicrobial usage, implement antibiotic stewardship practices, and enhance infection control procedures. […] Nevertheless, heterogeneity in testing, surveillance, infection prevention, and control practices prevails among hospitals globally and between countries.

• #8 Insights into the Evolving Epidemiology of Clostridioides difficile Infection and Treatment: A Global Perspective

  https://www.mdpi.com/2079-6382/12/7/1141

  The most recent 2020 surveillance data by the Center for Disease Control and Prevention showed an incidence of 101.3 cases per 100,000 persons, with 51.2% being CA-CDI and 50.1% being healthcare associated (HA)-CDI. […] The incidence of CDI, particularly HA-CDI, appears to have reached a plateau in recent years after increasing steadily over the previous decade. […] In a 2022 Europe-wide survey on the incidence of CDI involving 559 hospitals performed by the European Centre for Disease Prevention and Control (ECDC), the mean incidence of CDI was 3.48 cases per 10,000 patient days. […] While the incidence of HA-CDI has plateaued or declined in North America and Europe, it seems to be rising in Australia. […] Despite the disease burden of C. difficile in low- and middle-income countries, epidemiological data assessing the burden of CDI remain relatively scarce.

• #9 Insights into the Evolving Epidemiology of Clostridioides difficile Infection and Treatment: A Global Perspective

  https://www.mdpi.com/2079-6382/12/7/1141

  The most recent 2020 surveillance data by the Center for Disease Control and Prevention showed an incidence of 101.3 cases per 100,000 persons, with 51.2% being CA-CDI and 50.1% being healthcare associated (HA)-CDI. […] The incidence of CDI, particularly HA-CDI, appears to have reached a plateau in recent years after increasing steadily over the previous decade. […] In a 2022 Europe-wide survey on the incidence of CDI involving 559 hospitals performed by the European Centre for Disease Prevention and Control (ECDC), the mean incidence of CDI was 3.48 cases per 10,000 patient days. […] While the incidence of HA-CDI has plateaued or declined in North America and Europe, it seems to be rising in Australia. […] Despite the disease burden of C. difficile in low- and middle-income countries, epidemiological data assessing the burden of CDI remain relatively scarce.

• #10 Clostridioides difficile Infection (CDI) Surveillance | HAIs | CDC

  https://www.cdc.gov/healthcare-associated-infections/php/haic-eip/cdiff.html

  The Clostridioides difficile infection (CDI) Surveillance Program collects data for describing incidence and trends of these infections. […] Public health professionals and healthcare providers can use these data to further public health research and, in turn, health outcomes. […] The Clostridioides difficile infection (CDI) Surveillance Program identifies and monitors: CDI incidence and burden in communities and healthcare settings. […] Trends in disease over time, including changes in strain prevalence. […] In 2022, the incidence rate of CDI increased with age. Additionally, rates were higher in women than in men and higher in White persons than in persons of other races. […] There were 116.1 cases per 100,000 persons in EIP sites in 2022. […] Underlying conditions were common among CDI cases.

• #11 Clostridioides difficile Infection (CDI) Surveillance | HAIs | CDC

  https://www.cdc.gov/healthcare-associated-infections/php/haic-eip/cdiff.html

  The Clostridioides difficile infection (CDI) Surveillance Program collects data for describing incidence and trends of these infections. […] Public health professionals and healthcare providers can use these data to further public health research and, in turn, health outcomes. […] The Clostridioides difficile infection (CDI) Surveillance Program identifies and monitors: CDI incidence and burden in communities and healthcare settings. […] Trends in disease over time, including changes in strain prevalence. […] In 2022, the incidence rate of CDI increased with age. Additionally, rates were higher in women than in men and higher in White persons than in persons of other races. […] There were 116.1 cases per 100,000 persons in EIP sites in 2022. […] Underlying conditions were common among CDI cases.

• #12 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the colon, the longest part of the large intestine. […] Illness from C. difficile often occurs after using antibiotic medicines. It mostly affects older adults in hospitals or in long-term care settings. People not in care settings or hospitals also can get C. difficile infection. Some strains of the bacterium that can cause serious infections are more likely to affect younger people. […] Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities. These are places where germs spread easily, antibiotic use is common and people’s health puts them at high risk of getting an infection. […] Older age is a risk factor. In one study, the risk of becoming infected with C. difficile was 10 times greater for people age 65 and older compared with younger people. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #13 Clostridioides (Clostridium) difficile infections – Annual Epidemiological Report for 2016–2017

  https://www.ecdc.europa.eu/en/publications-data/clostridiodes-difficile-infections-annual-epidemiological-report-2016-2017

  On 1 January 2016, ECDC started coordinating the surveillance of Clostridioides (Clostridium) difficile infection (CDI) in acute care hospitals in EU/EEA countries. […] In 20162017, 24 EU/EEA countries/administrations (UK devolved administrations are counted separately) reported CDI data to ECDC, of which 23 countries had data suitable for analysis. […] Overall in 20162017, 72.0% of the CDI cases with case-based data were above 64 years old and the majority (56.4%) were female. […] In 20162017, the crude incidence density of CDI was 3.48 cases per 10 000 patient-days. […] In 20162017, 23 052/37 857 (60.9%) cases were HA CDI. […] In 20162017, 2 439/37 857 (6.4%) CDI cases were reported to be recurrent. […] In 20162017, 12 366/37 857 (32.7%) CDI cases were community-associated (CA CDI), or CDI of unknown association (UA CDI). […] ECDC recommends continual incidence surveillance of CDI for a period of 12 months.

• #14

  https://smw.ch/index.php/smw/article/view/3571

  AIMS: This study evaluated an approach to establishing a comprehensive nationwide surveillance system for Clostridioides difficile infection in Switzerland. We report the results of patient-related surveillance and calculate the incidence rate of C. difficile infection in Switzerland in 2022. […] This survey revealed an incidence of 3.8 (Poisson 95% CI: 3.24.5) C. difficile infection episodes per 10,000 patient-days, just above the mean rate reported by the European Centre for Disease Prevention and Control (ECDC). […] This study underscores the importance of a joint effort towards standardized surveillance practices in providing comprehensive insights into C. difficile infection epidemiology and effective prevention strategies in Swiss healthcare settings. The patient-related approach remains the gold standard for C. difficile infection surveillance, although it demands substantial resources and provides results only annually. The proposed implementation of nationwide automated laboratory-based surveillance would be pragmatic and efficient, empowering authorities and hospitals to detect outbreaks promptly and to correlate infection rates with antibiotic consumption.

• #15 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. […] Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. […] This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management. […] To increase comparability between clinical settings, use available standardized case definitions for surveillance of (1) healthcare facility-onset (HO) CDI; (2) community-onset, healthcare facility-associated (CO-HCFA) CDI; and (3) community-associated (CA) CDI (good practice recommendation).

• #16 Clostridium difficile Infection – CEIP

  https://ceip.us/projects/haic/clostridium-difficile-infection-surveillance/

  A CDI case will be categorized as healthcare facility-onset (HCFO) if the initial specimen that yielded the positive C. difficile toxin result was collected 3 calendar days after admission to a healthcare facility. […] Among CO cases, cases will be further classified either as community-onset healthcare facility-associated (CO-HCFA) or community-associated (CA). […] CDI cases that have a positive stool specimen for C. difficile from two to eight weeks of the last positive specimen will be considered as a recurrent episode of CDI. […] Yearly surveillance reports for pathogens under surveillance are available in PDF format at CDCs HAIC CDI Surveillance Reports site.

• #16 Clostridium difficile Infection – CEIP

  https://ceip.us/projects/haic/clostridium-difficile-infection-surveillance/

  CEIP conducts surveillance for Clostridioides difficile infection (CDI) through Healthcare-Associated Infections Community Interface. For each case of invasive disease in the study population, CEIP generates a case report with basic demographic information. […] Monitor population-based CDI incidence and disease burden of community- and healthcare-associated CDI over time to assess the impact of prevention strategies and inform public health practice. […] The main components of CDI surveillance are active, laboratory-based surveillance, stool testing at CDC for confirmatory results, and monthly transmission of data to CDC. […] A case of CDI is defined as a stool positive for C. difficile toxin by either enzyme immunoassay or molecular assay (e.g., PCR) on an incident stool specimen from a resident of San Francisco County.

• #17 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  Data from North America and Europe suggest that approximately 2027 percent of all CDI cases are community-associated, with an incidence of 2030 per 100,000 population. […] Recently the Centers for Disease Control and Prevention (CDC) launched an active, population-based surveillance for CDI through the Emerging Infections Program. […] One of the objectives is to describe the epidemiology of community-associated CDI (CA-CDI). […] In 2010, a total of 10,342 CDI cases were identified from across the U.S, of which 3,269 (32 percent) were CA-CDI. […] The ribotype 027 strain was the most prevalent strain identified in the CA-CDI population. […] Reports indicate the incidence of CDI among hospitalized children has also been increasing across the U.S. […] Most studies describing the epidemiology of CDI in children involve hospitalized patients, which likely underestimates the burden of disease in this population.

• #18 The burden of CDI in the United States: a multifactorial challenge | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08096-0

  Community-associated CDI, on the other hand, is on the rise, almost doubling in the past decade with an incidence of 63.3 cases per 100,000 persons. […] The incidence of rCDI has increased significantly in recent years and this has been identified as a major public health challenge. […] Data indicate that in the US, recurrence accounts for 75,000 to 175,000 additional cases of CDI per year. […] The most important risk factor for CDI is antibiotic use, with 60% of CDI cases using antibiotics in the 4 months prior to infection. […] The risk for CDI and rCDI is higher among patients who are female, older, have comorbidities, are immunosuppressed, have recently been hospitalized, and have a history of using corticosteroids, proton pump inhibitors, or lipid-lowering therapy. […] The clinical burden of CDI and rCDI is extensive.

• #19 About C. Diff – Peggy Lillis Foundation

  https://cdiff.org/about-c-diff/

  There are nearly 500,000 C. diff infections annually in the US. […] CDI recurs in about 1 in 5 patients. […] In 2011, CDI was the 17th leading cause of death for people aged 65 years and older. […] CDI significantly impairs patients’ quality of life both physically and emotionally because of the lack of control of bowel function and lack of understanding about the illness. […] CDI, particularly the nature of the diarrhea, negatively affects patients’ relationships with family, children and spouses. […] 29,000 Americans died from a CDI in 2011. […] Nursing home CDI cases alone led to 9,000 deaths in 2011. […] Costs include up to $6.2 billion in aggregated annual costs for hospital care of patients with CDI. […] The average cost per hospital stay for patients with CDI is $24,400, more than triple the cost (~$8,000) for other patients.

• #20 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Asymptomatic colonization is common in children, especially infants. Up to 63% of healthy neonates are colonized with C. difficile, and evidence suggests that hospitalization during birth is a factor. […] Transmission of C. difficile most likely occurs by person-to-person contact via the fecal-oral route or by direct exposure from the contaminated environment. […] The incubation period for C. difficile is up to one week, although recent studies suggest it could be longer. C. difficile survives outside the colon as spores that are resistant to heat, acid, and antibiotics. […] Recurrent C. difficile infection is defined by resolution of symptoms during therapy, then reappearance of symptoms two to eight weeks after treatment has ended. The recurrence rate for health care facility-acquired infections is 5% to 50% (median: 20%). A meta-analysis found that 13% to 50% of patients with C. difficile infection had at least one recurrence.

• #21 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A number of risk factors for CDI have been identified. The main risk factors for development of CDI are exposure to the healthcare environment, advanced age (65 years or older), and exposure to antibiotics. Receipt of an antimicrobial agent is the most significant modifiable risk factor for initial or recurrent CDI. […] Patients are at highest risk for CDI during antimicrobial therapy and within the first month after its discontinuation, and they continue to be at risk for 3 months after completion of therapy. […] Recurrent CDI may occur after completion of treatment, and approximately 25% of patients with a first episode of CDI will have a recurrent infection. The risk of recurrence increases with the number of CDI episodes, with up to 45% of patients experiencing recurrent CDI after the second episode and more than 60% having a recurrence after three or more episodes.

• #22 Clinical Practice Guidelines for the Management of Clostridioides difficile Infection in Adults: 2021 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridioides-difficile-2021-focused-update/

  This clinical practice guideline is a focused update on management of Clostridioides difficile infection (CDI) in adults specifically addressing the use of fidaxomicin and bezlotoxumab for the treatment of CDI. […] New estimates on the burden of CDI have also been reported by the Centers for Disease Control and Prevention. While the adjusted estimate for total CDI burden nationally decreased by 24% from the previous report, they still estimated 462 100 cases annually and the burden of first CDI recurrences was unchanged. Recurrent CDI remains one of the most important treatment challenges for clinicians, with estimates of 31 300 and 38 500 recurrences for community-associated and healthcare-associated cases, respectively, in 2017. […] The panel suggests the use of fidaxomicin as the preferred therapy for an initial CDI episode to improve sustained response after therapy but recognizes that vancomycin remains an acceptable alternative if fidaxomicin is not available. […] The panel suggests using bezlotoxumab as a co-intervention along with SOC antibiotics for patients with a recurrent CDI within the last 6 months to reduce the risk of a subsequent CDI recurrence after initial clinical cure.

• #23 Clostridioides difficile (C. diff) | Texas DSHS

  https://www.dshs.texas.gov/antibiotic-resistance-multidrug-resistant-organisms/clostridium-difficile-c-diff-infection

  Clostridioides difficile (C. diff) is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15-25% of all episodes of AAD. […] The risk for C. diff infections increases in patients with antibiotic exposure, proton pump inhibitors, gastrointestinal surgery/manipulation, a long length of stay in healthcare settings, a serious underlying illness, immunocompromising conditions, and advanced age. […] In 2013, the Texas legislature funded C. difficile prevention activities. The goal is to improve identification in the laboratory, the use of antibiotics, and ways to prevent infection. […] Individual cases of Clostridioides difficile (C. diff) are not a reportable condition in Texas. Report outbreaks to your local health department.

• #24 C. Diff. Infection (Clostridium Difficile Infection) | Spokane Regional Health District

  https://srhd.org/health-topics/diseases-conditions/c-diff-infection-clostridium-difficile-infection

  Clostridium difficile, a toxin-producing, spore-forming, anaerobic gram-positive bacillus, is a significant cause of infectious diarrhea, called C. difficile infection (CDI). […] Persons 65 years of age and older as well as those with multiple medical co-morbidities are at increased risk for CDI. […] Antibiotic exposure is the most important modifiable risk for acquisition of CDI. […] There is a well-defined dose-dependent increase in the risk of CDI with increasing dose and days of antibiotic exposure. […] The ability of clindamycin and cephalosporin to induce CDI is well known. Recently, fluoroquinolones have emerged as a significant risk factor. […] C. difficile is not part of the normal fecal flora in most people. Infection is most often acquired in a medical setting, such as a long-term care environment, hospital, or clinic, from a contaminated surface or a healthcare providers hands.

• #25

  https://step2.medbullets.com/infectious-dis/121798/clostridium-difficile-c-diff

  Epidemiology […] Incidence […] common […] Risk factors […] recent antibiotics use […] clindamycin […] ampicillin […] cephalosporins […] fluoroquinolones […] proton-pump inhibitors […] recent hospitalization […] advanced age […] […] […] Relapse occurs in ~20% of patients

• #26 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  Studies in North America and Europe have implicated the ribotype 027 strain in CDI outbreaks characterized by an increased incidence and severity, refractory to traditional therapy, and a greater risk of relapse. […] The increased burden of CDI places a significant financial constraint on the healthcare system. […] The acute-care direct costs of CDI in the U.S. were estimated to be $4.8 billion in 2008. […] However, the actual cost is likely higher when considering indirect costs associated the management of CDI. […] This review discusses the current epidemiology of CDI, including patient risk factors and future challenges. […] While the epidemiology of CDI has changed in the past decade, one of the most notable changes has been the apparent increased incidence among populations in the community who were historically considered to be at low risk, such as healthy peripartum women, children, antibiotic-nave patients, and those with minimal or no recent healthcare exposure.

• #27 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  CDI is more common in elderly people, and old age may promote susceptibility to colonization and disease. Cross-infection by C difficile is common in neonatal units, but neonates do not seem to develop C difficile associated diarrhea. More recently, there have been specific populations affected by C difficile that were previously believed to be at low risk, such as young, healthy persons not exposed to a hospital environment or antimicrobial therapy and young women in a peripartum setting. […] A study by Nylund et al suggested an increase in CDI among hospitalized children, especially in those with medical conditions such as IBD and immunosuppression. Also at risk are individuals hospitalized with conditions that require antibiotic administration.

• #28 About C. Diff – Peggy Lillis Foundation

  https://cdiff.org/about-c-diff/

  C. diff is the most common cause of infectious diarrhea in healthcare settings. […] C. diff caused nearly 500,000 infections in one year, and 29,000 deaths. […] CDI accounts for significant rates of illness and death. In 2011, C. difficile was the 17th leading cause of death for people aged 65 years and older. […] CDI is being increasingly recognized as a cause of diarrhea in the general community and in populations without the traditional risk factors for CDI. […] CDI recurs in about 1 in 5 patients. […] While the elderly and people with compromised immune systems are more vulnerable to CDIs, the primary risk factor is current or recent use of antibiotics, particularly those in these classes. […] CDI is the most common cause of infectious diarrhea in healthcare settings. […] An estimated 20,000 children get a CDI every year, according to a 2023 study in the Journal of Pediatrics.

• #29 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Asymptomatic colonization is common in children, especially infants. Up to 63% of healthy neonates are colonized with C. difficile, and evidence suggests that hospitalization during birth is a factor. […] Transmission of C. difficile most likely occurs by person-to-person contact via the fecal-oral route or by direct exposure from the contaminated environment. […] The incubation period for C. difficile is up to one week, although recent studies suggest it could be longer. C. difficile survives outside the colon as spores that are resistant to heat, acid, and antibiotics. […] Recurrent C. difficile infection is defined by resolution of symptoms during therapy, then reappearance of symptoms two to eight weeks after treatment has ended. The recurrence rate for health care facility-acquired infections is 5% to 50% (median: 20%). A meta-analysis found that 13% to 50% of patients with C. difficile infection had at least one recurrence.

• #30 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  As noted, it is important to remember that most of the published data on incidence (and economic costs) represent CDI diagnosed in the acute-care hospital setting and therefore likely underestimates the total burden of CDI on the overall healthcare system. […] C. difficile infection places a significant economic burden on the healthcare system. […] The acute-care direct costs of CDI in the U.S. were estimated to be $4.8 billion in 2008. […] Enhanced surveillance methods are needed to monitor the incidence, identify populations at risk, and characterize the molecular epidemiology of strains causing CDI.

• #31 About C. Diff – Peggy Lillis Foundation

  https://cdiff.org/about-c-diff/

  There are nearly 500,000 C. diff infections annually in the US. […] CDI recurs in about 1 in 5 patients. […] In 2011, CDI was the 17th leading cause of death for people aged 65 years and older. […] CDI significantly impairs patients’ quality of life both physically and emotionally because of the lack of control of bowel function and lack of understanding about the illness. […] CDI, particularly the nature of the diarrhea, negatively affects patients’ relationships with family, children and spouses. […] 29,000 Americans died from a CDI in 2011. […] Nursing home CDI cases alone led to 9,000 deaths in 2011. […] Costs include up to $6.2 billion in aggregated annual costs for hospital care of patients with CDI. […] The average cost per hospital stay for patients with CDI is $24,400, more than triple the cost (~$8,000) for other patients.

• #32 Xpert® C. difficile/Epi

  https://www.cepheid.com/en-US/tests/hai-other-infectious-diseases/xpert-c-difficile-epi.html

  Clostridioides difficile infection (CDI) accounts for 15-25% of healthcare-associated diarrhea cases in all healthcare settings. […] It is associated with an increase in length of hospital stay, high morbidity and mortality resulting in both societal and financial burden. […] Although the accurate and rapid diagnosis of CDI is essential for effective and timely treatment, this remains an unmet clinical need. […] The Xpert C. difficile/Epi test provides detection and differentiation of Clostridioides difficile the epidemic 027 strain, in 43 minutes from unformed stool specimens. […] Rapid detection and differentiation of Clostridioides difficile (CDI) the epidemic 027 strain optimizes patient management decisions and supports infection control and outbreak prevention measures. […] Rapid and accurate detection of toxigenic C. difficile is essential to diagnose CDI to implement optimized therapy and bed management and to help prevent transmission and outbreaks: 45% reduced empiric therapy, 48% reduced isolation days.

• #33 Clostridium Difficile Campaign

  https://dph.illinois.gov/topics-services/prevention-wellness/patient-safety-quality/cdiff-campaign.html

  The bacterium C. diff can result in deadly diarrhea. As the most important cause of antibiotic associated diarrhea, accounting for 15 to 25% of cases, C. diff infection (CDI) is an important patient safety issue. In Illinois, C. diff hospital discharges more than doubled from 7,082 to 16,262 between 1999 and 2010. Although the numbers for Illinois long term care facilities are not yet tracked, C. diff is recognized as problematic in this setting and may well mirror the burden seen nationally: in the US, there are roughly 263,000 cases of nursing home onset CDI annually compared with 165,000 cases of hospital acquired hospital onset CDI. Recent estimates show that inpatient health care costs for each case of hospital onset CDI is $5,047 to $7,179, a significant expense for the patient and healthcare system. […] CDI is preventable. The two groups of hospitals that participated in the Illinois C. diff Prevention Collaborative reduced their CDI rates by 15% and 26% during their participation period. […] Reduce rates of facility associated CDI in Illinois.

• #34 Clostridium Difficile: Infection prevention and control guidance for management in acute care settings – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/clostridium-difficile-infection-prevention-control-guidance-management-acute-care-settings.html

  A surveillance system should be established that includes systematic collection, analysis, interpretation and dissemination of C. difficile infection rates by unit in the facility. […] Prospective surveillance using accepted C. difficile infection case definitions and denominators should be established to determine the organization’s baseline rate and to monitor changes in the C. difficile infection rate.

• #35 Fact Sheet – Clostridium difficile (C. difficile) – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

  To better understand risk patterns and trends in Canada, C. difficile became a notifiable disease under national surveillance in 2009 through the Canadian Notifiable Disease Surveillance System. […] The Agency leads the Canadian Nosocomial Infection Surveillance Program (CNISP). […] As part of this program, participating hospitals report all cases of C. difficile infections. […] All these results are used to inform and improve surveillance activities and infection prevention and control guidance related to C. difficile across the country.

• #36 Clostridium difficile Infection (CDI) Surveillance – Emerging Infections Program – Center for Community Health & Prevention – University of Rochester Medical Center

  https://www.urmc.rochester.edu/community-health/surveillance-prevention/emerging-infections-program/c-difficile-surveillance

  C diff.C. difficile is a bacteria that causes diarrhea, and occasionally, severe infection, hospitalization, and death. The purpose of this surveillance in Monroe County is to monitor trends in C. difficile infection incidence and strain types in order to target prevention efforts. […] Describe the epidemiology of community- and healthcare-associated CDI and generate hypotheses for future research activities using EIP CDI surveillance infrastructure. […] The incidence of C. difficile infection by epidemiologic classification in Monroe County is shown below. […] Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes. […] Burden of nursing home-onset Clostridium difficile infection in the United States: estimates of incidence and patient outcomes. […] Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011.

• #37 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  At a minimum, conduct surveillance for HO-CDI in all inpatient healthcare facilities to detect elevated rates or outbreaks of CDI within the facility (weak recommendation, low quality of evidence). […] Express the rate of HO-CDI as the number of cases per 10,000 patient-days. Express the CO-HCFA prevalence rate as the number of cases per 1,000 patient admissions (good practice recommendation). […] Stratify data by patient location to target control measures when CDI incidence is above national and/or facility reduction goals or if an outbreak is noted (weak recommendation, low quality of evidence). […] Use the same standardized case definitions (HO, CO-HCFA, CA) and rate expression (cases per 10,000 patient-days for HO, cases per 1,000 patient admissions for CO-HCFA) in pediatric patients as for adults (good practice recommendation). […] Conduct surveillance for HO-CDI for inpatient pediatric facilities but do not include cases 2 years of age (weak recommendation, low quality of evidence). […] Consider surveillance for CA-CDI to detect trends in the community (weak recommendation, low quality of evidence).

• #38 Clostridioides difficile Infection (CDI) Surveillance | HAIs | CDC

  https://www.cdc.gov/healthcare-associated-infections/php/haic-eip/cdiff.html

  56% of CDI cases used antibiotics in the prior 12 weeks. […] EIP site staff identify cases based on reports of positive C. difficile toxin assay or C. difficile nucleic acid amplification assay from clinical, reference and commercial laboratories serving residents of the surveillance areas. […] A portion of cases subsequently undergo a comprehensive medical record review for clinical information and relevant risk factors. […] EIP site staff collect a convenience sample of stool specimens from incident CDI cases for whom case report forms have been completed.

• #39 Insights into the Evolving Epidemiology of Clostridioides difficile Infection and Treatment: A Global Perspective

  https://www.mdpi.com/2079-6382/12/7/1141

  Clostridioides difficile remains an important public health threat, globally. […] Understanding C. difficile epidemiology is increasingly important to allow for effective prevention measures. […] Despite the heightened epidemiological surveillance of C. difficile over the past two decades, it remains challenging to accurately estimate the burden and international epidemiological trends given the lack of concerted global effort for surveillance, especially in low- and middle-income countries. […] The emergence of a more virulent strain of C. difficile has been recognized as one of the principal drivers of the ongoing CDI epidemic. […] Over the last decade, new strains have been reported to cause CDI with worse health outcomes, such as ribotypes 014/020, 017, 056, 106, and 078/126. […] In North America, the incidence and severity of CDI have been well-documented.

• #40 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A multifactorial approach is recommended for the prevention of CDI. This includes infection prevention measures (e.g., hand hygiene, isolation precautions, contact precautions, and appropriate environmental cleaning and disinfection) as well as implementation of antimicrobial stewardship programs that restrict high-risk antibiotics and focus on minimizing the use and duration of unnecessary antimicrobial agents.

• #41 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Infection control and good antibiotic stewardship are the cornerstones for reducing the incidence of C. difficile infection in health care and community settings. Infection control requires a robust surveillance system to detect increased infection rates or outbreaks of C. difficile infection; in addition, key preventive strategies include use of contact precautions, good hand hygiene, environmental cleaning and disinfection, and patient bathing.

• #42 Clostridium difficile | Roche Molecular Diagnostics

  https://diagnostics.roche.com/us/en/products/product-category/clostridium-difficile.html

  There is a pressing need for reliable surveillance methods to detect outbreaks, and identify and treat patients quickly. The increased severity and incidence of C. difficile infections make accurate and rapid identification of the infection imperative. […] According to the CDC, hospitals that followed infection control recommendations lowered C. difficile infection rates by 20% in less than 2 years. […] Microbiology labs are an essential part of timely and accurate reporting of C. difficile infections, enabling clinicians to provide appropriate therapy and improve patient management.

• #43 Epidemiology of Clostridium difficile Infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4128635/

  Enhanced surveillance methods are needed to monitor the incidence, identify populations at risk, and characterize the molecular epidemiology of strains causing CDI. […] Data from the U.S. and Europe suggest the incidence of CDI may have reached a crescendo in recent years and is leveling off or slightly declining. […] However, the overall incidence of CDI has increased to the point of surpassing rates of methicillin-resistant S. aureus infections in the some areas of the U.S. as the most common cause of healthcare-associated infection. […] Paralleling this increased prevalence there has also been a corresponding increase in morbidity and mortality associated with CDI, which has coincided with the emergence and rapid spread of a previously rare strain, known synonymously as polymerase chain reaction (PCR) ribotype 027, North American Pulse-field type 1 (NAP1), or restriction endonuclease analysis (REA) type BI, heretofore referred to as ribotype 027.

• #44 Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit | Nature Medicine

  https://www.nature.com/articles/s41591-023-02549-4

  Our findings have important implications for the prevention of CDI going forward. While current practices can limit cross-transmission, our results indicate that further reductions in hospital-onset CDI will require developing more effective strategies to interrupt the transition from colonization to clinical infection.

• #44 Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit | Nature Medicine

  https://www.nature.com/articles/s41591-023-02549-4

  Despite enhanced infection prevention efforts, Clostridioides difficile remains the leading cause of healthcare-associated infections in the United States. Current prevention strategies are limited by their failure to account for patients who carry C. difficile asymptomatically, who may act as hidden reservoirs transmitting infections to other patients. […] Together, these findings suggest that current infection prevention practices can be effective in preventing nosocomial cross-transmission of C. difficile, and that decreasing C. difficile infections in hospitals further will require interventions targeting the transition from asymptomatic carriage to infection. […] Asymptomatic carriers of C. difficile, defined as persons who carry the C. difficile organism without clinical symptoms indicative of C. difficile infection, could be underappreciated reservoirs of C. difficile within healthcare settings.

• #45 Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit | Nature Medicine

  https://www.nature.com/articles/s41591-023-02549-4

  Our findings have important implications for the prevention of CDI going forward. While current practices can limit cross-transmission, our results indicate that further reductions in hospital-onset CDI will require developing more effective strategies to interrupt the transition from colonization to clinical infection.

• #46 The global burden and trend of Clostridioides difficile and its association with world antibiotic consumption, 1990–2019 — JOGH

  https://jogh.org/2024/jogh-14-04135

  The global burden and trend of Clostridioides difficile and its association with world antibiotic consumption, 1990–2019 […] To estimate the global trends and disease burden of Clostridioides difficile infection (CDI) and its correlation with worldwide antibiotic consumption. […] Clostridioides difficile infection and antibiotic consumption data were retrieved from the Global Burden of Disease 2019, ResistanceMap-AntibiocUse, Food and Drug Administration (FDA) Adverse Event Reporting System, and Global Antimicrobial Resistance and Use Surveillance System. Jointpoint regression and age-period-cohort model were developed to show the global trends and burden of CDI. Correlation tests were calculated to explore the relationship between CDI and antibiotics. […] Globally, CDI is the most significant one with a high-rocketing burden increase rate among 13 pathogens causing diarrheal deaths and disability-adjusted life years (DALYs). The age-standardised death rate (ASDR) increased from 0.19 in 1990 to 0.43 in 2019, in which the elderly and females are at higher risk. A rapid increase in ASDR in high to middle sociodemographic index (SDI) regions such as North America (average annual percentage change (AAPC) = 7.71%), Andean (AAPC = 7.82%), and Southern Latin America (AAPC = 11.08%) was identified. Antibiotic consumption has a significant positive correlation with CDI with different risk stratifications.

• #47 The global burden and trend of Clostridioides difficile and its association with world antibiotic consumption, 1990–2019 — JOGH

  https://jogh.org/2024/jogh-14-04135

  The global burden of CDI has continuously increased for the past 30 years, especially in high to middle-SDI regions. World antibiotic consumption showed a strong positive correlation with CDI with different risk stratification. More effective prevention and control measures should be implemented in these critical regions, with a specific emphasis on vulnerable populations, to mitigate the spread of epidemics. […] Clostridioides difficile, as a spore-forming, gram-positive bacillus responsible for the spectrum from infectious diarrhoea and pseudomembranous colitis to megacolon and death, stands as one of the most common health care-associated infections. Clostridioides difficile’s spores can easily colonise in intestinal epithelia and activate when antibiotics disrupt healthy indigenous microbiota, making it the leading cause of antibiotic-associated diarrhoea. By producing TcdA (toxin A) and TcdB (toxin B), toxigenic strains depolymerise epithelia cells’ actin through Rho GTPase inactivation and then stimulate the inflammatory cascade, leading to gut damage and severe diarrhoea. The rapid spreading of hypervirulent strains such as North American pulsed-field gel electrophoresis type 1 (NAP1)/027 propels Clostridioides difficile infection (CDI) to become an urgent threat infection announced by the Centres for Disease Control and Prevention (CDC). The report published in 2015 based on CDC Emerging Infections Program (EIP) data in 2011 revealed 453,000 incident infections and 29,000 deaths in the USA. It has been demonstrated from CDC’s Antibiotic Resistance Threats in the USA that CDI caused around 223,900 estimated cases in hospitalised patients in 2017, and 12,800 estimated deaths, and 1 billion US dollars (USD) attributable health care costs. A European prospective point-prevalence multicentre study reported 7.0 cases of CDI per 10,000 patient-bed days in hospital. And some studies reported considerably varied mortalities of CDI: the all-cause mortality at 30-day is from 9 to 38%, and attributable mortality at 30 days could range from 5.7 to 6.9%, indicating the importance of understanding the epidemiology characteristics of CDI.

Zobacz więcej