2076. Increasing Incidence of Community-Acquired Clostridium difficile Infections Among Hospitalized Patients
Session: Poster Abstract Session: Clostridium difficile: Epidemiology
Saturday, October 29, 2016
Room: Poster Hall

Background: The incidence of Clostridium difficile infection (CDI) in US hospitals continues to increase. Better understanding of the epidemiology of hospitalized patients with CDI is needed to inform prevention efforts.

Methods: Twenty-five hospitals participating in the Duke Infection Control Outreach Network (DICON) from 1/1/2011 through 12/31/2015 were included in the analysis. CDI events were categorized as healthcare facility associated (HCFA) or community-acquired (CA) according to NHSN HAI surveillance definitions. Characteristics of CDI case patients were compared between CDI event categories. Poisson regression was used to model annual trends in CDI incidence rates over time, adjusting for clustering by hospital and molecular test use.

Results: 11,844 CDI events occurred over 6,394,962 patient days. 6038 (51%) of all CDI cases were CA (Table). From 2011 to 2015, the adjusted annual incidence rate of CA-CDI increased from 0.46 to 0.89 cases per 1,000 patient-days (IRR 1.92, 95% CI 1.56-2.37), whereas HCFA-CDI also increased but to a lesser extent (IRR 1.42, 95% CI 1.18-1.71; Figure).

Conclusion: Half of hospitalized patients with CDI had community-acquired infections, and from 2011 to 2015, the incidence rate of CA-CDI nearly doubled. CDI prevention efforts should target this emerging population. 

Table: Clinical features of CDI Case Patients: Duke Infection Control Outreach Network 2011-2015

Total

N (%)

CA

N (%)

HCFA

N (%)

P value

11,844

6038 (51)

5806 (49)

Gender

<0.001

     Male

4508 (39.0)

2147 (36.5)

2361 (41.6)

     Female

7049 (61.0)

3739 (63.5)

3310 (58.4)

     Missing

287

152

135

Age, mean (IQR)

69 (56, 80)

68 (54, 80)

70 (58, 81)

<0.001

     <50

1939 (16.4)

1185 (19.6)

754 (13.0)

<0.001

     >80

2859 (24.1)

1388 (23.0)

1471 (25.3)

0.003

Admitted from

<0.001

     Home

8615 (73.5)

4748 (79.4)

3867 (67.3)

     LTCF

2591 (22.1)

1050 (17.6)

1541 (26.8)

     Hospital

392 (3.3)

123 (2.1)

269 (4.7)

     Other

127 (1.1)

56 (0.9)

71 (1.2)

LOS post culture, days (IQR)

4 (2, 8)

4 (2, 7)

5 (2, 9)

<0.001

Disposition

<0.001

     Home

4867 (57.3)

2880 (67.7)

1987 (46.9)

     LTCF

2419 (28.5)

931 (21.9)

1488 (35.1)

     Hospital

235 (2.8)

99 (2.3)

136 (3.2)

     Death

872 (10.3)

300 (7.1)

572 (13.5)

     Other

98 (1.2)

45 (1.1)

53 (1.3)

     Missing

3353

 

Sarah S. Lewis, MD MPH1,2,3,4, Arthur W. Baker, MD, MPH2,5, Rebekah W. Moehring, MD, MPH1,2,3,4,6, Daniel Sexton, MD2,3,5 and Deverick Anderson, MD, MPH, FIDSA, FSHEA2,3,4,5, (1)Duke Infection Control Outreach Network (DICON), Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)Duke Antimicrobial Stewardship Outreach Network, Durham, NC, (4)Duke University CDC Prevention Epicenter Program, Durham, NC, (5)Duke Infection Control Outreach Network, Durham, NC, (6)Durham VA Medical Center, Durham, NC

Disclosures:

S. S. Lewis, None

A. W. Baker, None

R. W. Moehring, None

D. Sexton, None

D. Anderson, None

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