Characterization of Healthcare-Associated and Community-Associated <i>Clostridioides difficile</i> Infections among Adults, Canada, 2015–2019
Tim Du, Kelly Baekyung Choi, Anada Silva, George R. Golding, Linda Pelude, Romeo Hizon, Ghada N. Al‐Rawahi, James Brooks, Blanda Chow, Jun Chen Collet, Jeannette Comeau, Ian Davis, Gerald A. Evans, Charles Frenette, Guanghong Han, Jennie Johnstone, Pamela Kibsey, Kevin Katz, Joanne M. Langley, Bonita E. Lee, Yves Longtin, Dominik Mertz, Jessica Minion, Michelle Science, Jocelyn A. Srigley, Paula Stagg, Kathryn N. Suh, Nisha Thampi, Alice Wong, Susy Hota
Abstract
We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015-2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015-2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.