Clostridium difficile (C. difficile) Surveillance
The Emerging Infections Program (EIP) Clostridium difficile infection (CDI) surveillance is being conducted in all ten EIP sites throughout the United States. Clostridium difficile is an anaerobic, spore-forming, gram positive bacillus that produces two pathogenic toxins: A and B. CDI ranges in severity from mild diarrhea to fulminant colitis and death. The primary risk factor for development of CDI in healthcare settings is recent antimicrobial use. Other risk factors for CDI acquisition in these settings are age greater than 65 years, severe underlying illness, intensive care unit admission, nasogastric intubation, use of Proton Pump Inhibitors and longer duration of hospital stay. Transmission of C. difficile is thought to occur primarily in healthcare facilities, where environmental contamination by C. difficile spores and exposure to antimicrobial drugs are common. No longer limited to healthcare environments, community-associated CDI is the focus of increasing attention. The sources of C. difficile and the risks for developing CDI in community populations, previously thought to be low-risk, are not well defined. The possibility of foodborne transmission from animal source has been suggested. Further studies are needed to understand the implications of isolating C. difficile from meat and potentially from food producing animals. The purpose of the surveillance system is to determine the population-based incidence of community-and healthcare-associated CDI among participating EIP sites; characterize C. difficile strains that are responsible for CDI in the population under surveillance with a focus on strains from community-associated cases; and describe the epidemiology of CDI and generate hypotheses for future research activities using EIP CDI surveillance infrastructure.
Goals & Objectives
- Determine the population-based incidence of community- and healthcare-associated CDI among participating EIP sites.
- Characterize C. difficile strains that are responsible for CDI in the population under surveillance with a focus on strains from community-associated cases.
- Describe the epidemiology of community- and healthcare-associated CDI and generate hypotheses for future research activities using EIP CDI surveillance infrastructure.
In Connecticut, CDI laboratory-based surveillance will be conducted for all toxin-positive C. difficile cases that reside in New Haven and Waterbury areas. A list of all positive C. difficile tests will be evaluated to determine individual cases and classify the cases as either Community Onset (Health Care Associated or Community Associated) or Health Care Onset. Each presumptive community-associated case, each community-onset healthcare associated case, and a 10% sample of health-care onset cases will also require full chart review to complete the case report form. Select laboratories will save stool samples on all cases of CDI for further laboratory evaluation including culture and toxinotype testing.
Recent C. difficile Publications
Centers for Disease Control and Prevention: Deadly Diarrhea: C. difficile Causes Immense Suffering, Death
Project Contact Person
Danyel Olson, MPH
Connecticut Emerging Infections Program
One Church Street, 7th floor
New Haven, CT 06510