Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 16;8(4):E737-E746.
doi: 10.9778/cmajo.20190191. Print 2020 Oct-Dec.

Time trends and predictors of laboratory-confirmed recurrent and severe Clostridioides difficile infections in Manitoba: a population-based study

Seth R Shaffer  1 , Zoann Nugent  1 , Andrew Walkty  1 , B Nancy Yu  1 , Lisa M Lix  1 , Laura E Targownik  1 , Charles N Bernstein  1 , Harminder Singh  2
Affiliations

Time trends and predictors of laboratory-confirmed recurrent and severe Clostridioides difficile infections in Manitoba: a population-based study

Seth R Shaffer et al. CMAJ Open. .

Abstract

Background: Many previous studies of Clostridioides difficile infection (CDI) epidemiology have used hospital discharge data codes, which can have limited accuracy. We used a data set of laboratory-confirmed cases of CDI in the province of Manitoba, Canada, to describe the epidemiology of CDI over a decade.

Methods: We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included (n = 8471) and followed up from CDI diagnosis. We assessed time trends of CDI, incidence and predictors of recurrence and severe outcomes, and health care encounters after CDI diagnosis. CDI episodes were stratified by community versus hospital site of acquiring CDI.

Results: Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital.

Interpretation: Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Harminder Singh has been on advisory boards or served as a consultant to Takeda Canada, Pendopharm, Ferring Canada, Merck Canada and Guardant Health, Inc. and has received an educational grant from Ferring Canada and research funding from Merck Canada for an independent investigator grant. Charles Bernstein has served on advisory boards or as a consultant to AbbVie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada and Mylan Pharmaceuticals and has received unrestricted educational grants from AbbVie Canada, Janssen Canada, Pfizer Canada, Shire Canada and Takeda Canada. He has been on the speaker’s bureau for Janssen Canada, Takeda Canada, Ferring Canada and Medtronic Canada. Laura Targownik has served on the advisory boards for Pfizer Canada, Takeda Canada, AbbVie Canada and Janssen Canada and on speaker panels for Janssen Canada, Takeda Canada and Pfizer Canada. She has received grant support from Pfizer Canada and AbbVie Canada. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Age-standardized CDI rates in Manitoba, 2005 to 2015. Note: CDI = Clostridioides difficile infection, HCF = health care facility.
Figure 2:
Figure 2:
Proportion of CDI cases that were community-associated, 2005 to 2015. Note: CDI = Clostridioides difficile infection.
Figure 3:
Figure 3:
Inpatient status for all incident and recurrent CDI in the 30 days following laboratory confirmation of CDI among those who were outpatients at CDI onset. Note: CDI = Clostridioides difficile infection.
See this image and copyright information in PMC

References

    1. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015;372:1539–48. - PubMed
    1. Lambert PJ, Dyck M, Thompson LH, et al. Population-based surveillance of Clostridium difficile infection in Manitoba, Canada, by using interim surveillance definitions. Infect Control Hosp Epidemiol. 2009;30:945–51. - PubMed
    1. Singh H, Nugent Z, Yu BN, et al. Hospital discharge abstracts have limited accuracy in identifying occurrence of Clostridium difficile infections among hospitalized individuals with inflammatory bowel disease: a population-based study. PLoS One. 2017;12:e0171266. - PMC - PubMed
    1. Singh H, Nugent Z, Yu B, et al. Assessment of Clostridium difficile epidemiology among individuals with IBD from hospital admissions databases provides a different picture than that from the laboratory confirmed diagnosis. Gastroenterology. 2019;156:S–674.
    1. Dubberke ER, Butler AM, Nyazee HA, et al. The impact of ICD-9-CM code rank order on the estimated prevalence of Clostridium difficile infections. Clin Infect Dis. 2011;53:20–5. - PMC - PubMed

Publication types