Characterization of Adult and Pediatric Healthcare-Associated and Community-Associated Clostridioides difficile Infections, Canada, 2015-2022

Abstract

We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult and pediatric patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015-2022. Of 30,824 reported CDI cases, 94.9% (29,250/30,824) were among adult (73.2% HA; 26.8% CA) and 5.1% (1,574/30,824) pediatric (77.6% HA; 22.4% CA) patients. During the study period, adult HA CDI rates decreased by 19.9% and CA CDI rates remained stable; pediatric HA CDI rates decreased by 29.6% and CA CDI decreased by 58.3%. Ribotype (RT) 106 was most common among both groups and replaced RT027 as the predominant strain type. RT027 was most associated with adult patients, HA acquisition, severe CDI, and severe outcomes. Moxifloxacin resistance was higher in adult than pediatric cases; clindamycin and rifampin resistance rates were similar between groups. Continued national surveillance is integral to understanding the epidemiology of adult and pediatric CDI in Canada and informing prevention efforts.

Keywords: Canada; Clostridioides difficile; Clostridioides difficile infection; adult CDI; antimicrobial resistance; bacteria; community-associated CDI; enteric infections; healthcare-associated CDI; healthcare-associated infection; nosocomial; pediatric CDI; ribotype.

Figure 1

National adult and pediatric healthcare-associated and community-associated Clostridioides difficile infection (CDI) rates, Canada, 2015–2022. A) Healthcare-associated CDI; B) community-associated CDI.

Figure 2

Regional adult and pediatric healthcare-associated and community-associated Clostridioides difficile infection (CDI) rates, Canada, 2015–2022. A) Healthcare-associated CDI; B) community-associated CDI. Western region includes British Columbia, Alberta, Saskatchewan, and Manitoba; Central region includes Ontario and Quebec; Eastern region includes Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland and Labrador. Northern region is Nunavut. The Northern region has reported 0 cases of CDI since they started conducting surveillance in 2020.

Figure 3

Percentages of 5 most common ribotypes detected among isolates in a characterization of adult healthcare-associated and community-associated Clostridioides difficile infection (CDI), Canada, 2015–2022. A) Healthcare-associated CDI rates; B) community-associated CDI rates. RT, ribotype.

Figure 4

Percentages of 5 most common RTs detected among isolates in a characterization of pediatric healthcare-associated and community-associated Clostridioides difficile infection (CDI), Canada, 2015–2022. A) Healthcare-associated CDI rates; B) community-associated CDI rates. RT, ribotype.