Clostridium Difficile Infection Rates in the U.S. in 2011

Clinical question: What are the incidence, recurrence rate, and mortality rate of Clostridium difficile infection (CDI) in the U.S. in 2011?

Background: CDI has continued to change, and its impact on healthcare has continued to increase.

Study design: Cross-sectional analysis.

Setting: U.S.

Synopsis: The incidence, rate of recurrence, and rate of mortality of C. diff were estimated using 10 sites from the CDC Emerging Infections Program. C. diff incidence was estimated at 453,000 cases, with higher rates among females, whites, and those over age 65. One-third of the cases were community associated. There were an estimated 83,000 first-time recurrent infections and 29,300 estimated deaths within 30 days of diagnosis, with half of those deaths attributable to CDI itself.

This study was limited by the reliance of the case definition solely on positive test results and the trend of labs transitioning to nucleic acid amplification testing (NAAT), both of which can lead to inclusion of colonization (not just actual disease). Also, the recurrence and mortality rates were underestimated, because the study only included first-time recurrences and deaths that were documented in the medical record.

Bottom line: C. diff caused nearly half a million infections and was associated with roughly 29,000 deaths in the U.S. in 2011.

Citation: Less FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825-834.

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