Summary
Introduction
Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated (HA) diarrhoea. We retrospectively
investigated data from a comprehensive, multidisciplinary C. difficile surveillance programme focusing on hospitalized patients in a tertiary Irish hospital
over 10 years.
Methods
Data from 2012 to 2021 were extracted from a centralized database, including patient
demographics, admission, case and outbreak details, ribotypes (RTs), and (since 2016)
antimicrobial exposures and CDI treatments. Counts of CDI by origin of infection were
explored using ꭓ2 analyses, Poisson regression was used to investigate trends in rates of CDI and possible
risk factors. Time to recurrent CDI was examined by a Cox proportional hazards regression.
Results
Over 10 years, 954 CDI patients had a 9% recurrent CDI rate. CDI testing requests
occurred in only 22% of patients. Most CDIs were HA (82.2%) and affected females (odds
ratio: 2.3, P<0.01). Fidaxomicin significantly reduced the hazard ratio of time to recurrent CDI.
No trends in HA-CDI incidence were observed despite key time-point events and increasing
hospital activity. In 2021, community-associated (CA)-CDI increased. RTs did not differ
for HA versus CA for the most common RTs (014, 078, 005 and 015). Average length-of-stay
differed significantly between HA (67.1 days) and CA (14.6 days) CDI.
Conclusion
HA-CDI rates remained unchanged despite key events and increased hospital activity,
whereas by 2021, CA-CDI was at its highest in a decade. The convergence of CA and
HA RTs, and the proportion of CA-CDI, question the relevance of current case definitions
when increasingly patients receive hospital care without an overnight hospital stay.
Keywords
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 18,
2023
Received:
December 21,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
