What is the prevalence of Clostridioides difficile (C. diff) infections?

Prevalence of Clostridioides difficile Infections

Clostridioides difficile infection (CDI) is a common healthcare-associated infection with an incidence rate of approximately 7.4 per 10,000 patient-days in the United States, while in Taiwan the incidence ranges from 1.1 to 7.3 per 10,000 patient-days depending on the region. 1

Global Epidemiology

Hospital-Associated CDI

• In the United States:

  • Incidence: 7.4 per 10,000 patient-days 1
  • Disease-related in-hospital mortality: 0.48-4.5% 1
  • Overall in-hospital mortality: 11.8-15.2% 1

• In Taiwan:

  • Highest incidence in central Taiwan: 5.8-7.3 per 10,000 patient-days 1
  • Northern Taiwan: 4.6-6.3 per 10,000 patient-days 1
  • Southern Taiwan: 1.1-4.8 per 10,000 patient-days 1
  • Overall in-hospital mortality: 20-26.2% 1
  • Community-onset CDI mortality: 4.7% 1

Trends Over Time

• In the United States, CDI hospital discharge diagnoses more than doubled from approximately 148,900 in 2001 to 301,200 in 2005 1
• CDI incidence increased from 4.5/1000 adult discharges in 2001 to 8.2/1000 discharges in 2010 1
• The annual attributable costs exceed $1.5 billion in the U.S. 1

Pediatric CDI Prevalence

• Asymptomatic carriage rates in children:

  • Infants ≤6 months: 30-73% 1
  • By age 3 years: Similar to adults (0-3%) 1
  • Children can have toxin detected in approximately 15% of 12-month-old infants 1

• Pediatric CDI hospitalization trends:

  • U.S. data shows increase from 2.6 per 100,000 hospitalizations in 1991 to 32.6 per 100,000 hospitalizations in 2009 1
  • However, a Canadian study showed no significant change in CDI incidence rates (7.8 per 100,000 person-years) between 2005 and 2015 1

Recurrence Rates

• First recurrence after initial CDI: 6-23% of patients 1
• Second recurrence after first recurrence: 20-36% of patients 1
• Among those with a second recurrence, 40-65% will experience subsequent recurrences 1
• In Taiwan, recurrence rates in medical centers: 7.2-10.9% 1
• Recurrence rates in pediatric CDI: 2.6-30% 1
• Second or subsequent recurrences in pediatric CDI: 14.5-32% 1

Risk Factors for CDI

Primary Risk Factors

• Antibiotic exposure (most important risk factor) 1
• Age above 65 years 1
• Prolonged hospital stay 1
• Use of proton pump inhibitors (PPIs) 1

Additional Risk Factors

• Inflammatory bowel diseases 1
• Oncological diseases 1
• Hematopoietic stem cell transplantation 1
• Chronic kidney disease 1
• End-stage renal disease 1
• Need for mechanical ventilator support 1
• Recent hospitalization 1
• Receipt of multiple antibiotics 1
• Longer antibiotic use duration 1
• Chemotherapy 1
• Feeding tubes 1

Special Populations

Immunocompromised Patients

• CDI ranges from 6-33% in hematology-oncology populations 1
• Most cases occur in the first month post-transplantation 1
• Incidence in transplant patients:
  • Kidney transplant: 0.77-11.3% 1
  • Liver transplant: 0.63-19% 1
  • Lung transplant: 1.93-22.9% 1
• In HIV-infected patients: 7.1-8.3 cases per 1000 patients/year 1

Clinical Implications

The high prevalence of CDI, especially in healthcare settings, underscores the importance of appropriate diagnostic testing and treatment protocols. The significant recurrence rates highlight the need for effective initial treatment and recurrence prevention strategies.

It's important to note that laboratory testing alone cannot distinguish between asymptomatic colonization and symptomatic infection with C. difficile 1. Testing should only be performed in symptomatic patients with appropriate clinical presentation (≥3 unformed stools in 24 hours) and risk factors 1.

For children, testing is not recommended for those under 12 months due to high asymptomatic carriage rates, and for children 1-2 years of age, testing should only be done after excluding other causes of diarrhea 1.