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
Select Publications and Presentations
Antimicrobial Susceptibility of Clostridium difficile Isolates Collected in the United States. Maria Karlsson, Karen Anderson, Ashley Paulick, Davina Campbell, Alice Guh, James K. Rasheed and the CDI Pathogen Working Group. European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). Vienna, Austria. 2017
Evaluation of Factors Associated with the Decrease in Incidence of Long-term Care Facility Onset Clostridium difficile Infections, 2011-2014. . Society for Healthcare Epidemiology of America (SHEA). Atlanta, GA. 2016
Trends in the incidence of Clostridium difficile Infection (CDI) in New Haven County, CT 2011-2015. J Meek, C Lyons, D Olson, J Hadler, Robert Heimer. Northeast Epidemiology Meeting. Saratoga Springs, NY. 2016
Trends in the incidence of Clostridium difficile Infection (CDI) in New Haven County, CT 2011-2015.. Carol Lyons, Danyel Olson, James Meek, James Hadler, Robert Heimer. American Public Health Association. Denver, CO. 2016
Trends in the incidence of Clostridium difficile Infection (CDI) in New Haven County, CT 2011-2015.. Carol Lyons, Danyel Olson, James Meek, James Hadler, Robert Heimer. Connecticut Infectious Disease Society. West Haven, CT. 2016
PREVALENCE OF CLOSTRIDIUM DIFFICILE RIBOTYPE 106 IN THE UNITED STATES, 2012-2014. Paulick, A.; Karlsson, M.; Albrecht, V.; Granade, M.; Guh, A.; Rasheed, J.K.; Limbago, B.; and the EIP CDI Pathogen Group. Anaerobe Conference. Nashville, TN. 2016
MOLECULAR EPIDEMIOLOGY OF CLOSTRIDIUM DIFFICILE ISOLATED IN THE UNITED STATES, 2014. Karlsson M, Paulick A., Albrecht V., Granade M., Guh A., Rasheed J.K., Limbago B. and the EIP CDI Pathogen Group. Anaerobe Conference. Nashville, TN. 2016
Assessment of Risk Factors for Community-Associated Clostridium Difficile Infection (CA-CDI) in a Connecticut Sample. S Greissman, J Hadler, D Weinberger, C Lyons, J Meek. Yale School of Public Health. New Haven, CT. 2015
Risk Factors for Community-Associated Clostridium difficile Infection: a case control study. Susan N. Hocevar, Ghinwa Dumyati, Claire Reisenauer , Rebecca Perlmutter, Erin Parker, Stacy Holzbauer, Corinne M. Davis, Emily Hancock, Carol Lyons, Cliff L. McDonald. ID Week. San Diego, CA. 2015
National estimates of incidence, recurrence, hospitalizatn, and death of nursing home-onset Clostridium difficile infections - United States, 2012. J Hunter, Y Mu, G Dumyati, M Farley, L Winston, H Johnston, J Meek, L Wilson, S Holzbauer, Z Beldavs, E Phipps, J Dunn, J Cohen, J Avillan, N Stone, LC McDonald, F Lessa. Epidemic Intelligence Service Annual Conference. Atlanta, GA. 2015
Area-based Poverty and Community Associated Clostridium difficile Infection in New Haven County, 2011-2013. Ranjit Dhaliwal, Kim Yousey-Hindes, Robert Heimer. Yale School of Public Health. New Haven, CT. 2014
National estimates of incidence, recurrence, hospitalization, and death of nursing home-onset Clostridium difficile infections — United States, 2012. Jennifer C. Hunter, Yi Mu, Ghinwa K. Dumyati, Monica M. Farley, Lisa G. Winston, Helen L. Johnston, James I. Meek, Lucy E. Wilson, Stacy M. Holzbauer, Zintars G. Beldavs, Erin C. Phipps, John R. Dunn, Jessica A. Cohen, Nimalie Stone, L. Clifford McDonald. ID Week. Philadelphia, PA. 2014
Related LinksCenters for Disease Control and Prevention - Clostridium difficile Surveillance
JAMA Internal Medicine Video: Epidemiology of Community-associated C. difficile Infection, 2009-2011
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