1405. Clostridium difficile infection (CDI) treatment practices in San Francisco County, 2012
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • CEIP_Garcia.pdf (169.7 kB)
  • Background:

    Treatment recommendations for Clostridium difficile infection (CDI) include oral metronidazole for mild to moderate infection and oral vancomycin for severe disease. Fidaxomicin is a recently approved treatment that may be associated with lower recurrence risk, and fecal transplant therapy is receiving increased attention, especially for recurrent disease.  We sought to characterize current treatment practices for CDI.


    Active population-based surveillance for laboratory confirmed CDI was conducted in San Francisco County (SF) from Jan 1 through Dec 31, 2012 as part of the CDC’s Emerging Infections Program (EIP). A CDI case was defined as a C. difficile-toxin positive stool collected from a SF resident ≥1 year of age without a positive test in the prior 8 weeks. Demographic and clinical information and CDI treatment within 7days of positive stool was abstracted from medical records.


    933 cases were identified; treatment information was available for 431 (46%) cases. Of these, 377 (87%) received antibiotic treatment: metronidazole was used in 254 (59%) cases, vancomycin in 169 (39%), fidaxomicin in 4 (1%), and probiotics in 8 (2%). Of those who received treatment, 39 (9%) had recurrent disease (an additional positive test in the 8 weeks following initial test) and 14 (3%) resulted in death. Among those hospitalized within 7 days after stool collection (234) vs. non-hospitalized cases (197): 102 (44%) and 98 (50%), respectively, were treated with metronidazole, 75 (32%) and 41 (21%) with vancomycin, and 37 (16%) and 12 (6%) with both metronidazole and vancomycin.


    In 2012, use of fidaxomicin was limited in SF. Increased use may be observed due to approval of add-on payments to acute care hospitals for Medicare inpatients treated with fidaxomicin. Medical record review did not identify fecal transplant as therapy for CDI in 2012, but future use of this treatment may be observed given recent positive studies. The 9% recurrence rate detected is much lower than the 20% rate suggested in the literature. Continued collection of these data will allow EIP’s CDI surveillance program to track changes in treatment patterns and recurrence rates over time.

    Erin P Garcia, MPH, CPH1, Erin Parker, MPH1, Joelle Nadle, MPH1 and Lisa G Winston, MD2, (1)California Emerging Infections Program, Oakland, CA, (2)University of California, San Francisco/San Francisco General Hospital, San Francisco, CA


    E. P. Garcia, None

    E. Parker, None

    J. Nadle, None

    L. G. Winston, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.