Cited by 2,641Clostridium difficile and Clostridium perfringens researchInfection Control in HealthcareAntimicrobial Resistance in Staphylococcus

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Burden of Clostridium difficile Infection in the United States

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Lessa, Fernanda C., Mu, Yi, Bamberg, Wendy M., Beldavs, Zintars G., Dumyati, Ghinwa K., Dunn, John R., Farley, Monica M., Holzbauer, Stacy M., Meek, James I., Phipps, Erin C., Wilson, Lucy E., Winston, Lisa G., Cohen, Jessica A., Limbago, Brandi M., Fridkin, Scott K., Gerding, Dale N., McDonald, L. Clifford·2015·New England Journal of Medicine

DOI 10.1056/nejmoa1408913PMC PMC10966662

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Abstract

BACKGROUND: The magnitude and scope of Clostridium difficile infection in the United States continue to evolve. METHODS: In 2011, we performed active population- and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents ≥ 1 year of age). Cases were classified as community-associated or health care-associated. In a sample of cases of C. difficile infection, specimens were cultured and isolates underwent molecular typing. We used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection. RESULTS: A total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8% were health care-associated, but only 24.2% had onset during hospitalization. After adjustment for predictors of disease incidence, the estimated number of incident C. difficile infections in the United States was 453,000 (95% confidence interval [CI], 397,100 to 508,500). The incidence was estimated to be higher among females (rate ratio, 1.26; 95% CI, 1.25 to 1.27), whites (rate ratio, 1.72; 95% CI, 1.56 to 2.0), and persons 65 years of age or older (rate ratio, 8.65; 95% CI, 8.16 to 9.31). The estimated number of first recurrences of C. difficile infection was 83,000 (95% CI, 57,000 to 108,900), and the estimated number of deaths was 29,300 (95% CI, 16,500 to 42,100). The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among health care-associated infections than among community-associated infections (30.7% vs. 18.8%, P<0.001). CONCLUSIONS: C. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011. (Funded by the Centers for Disease Control and Prevention.).

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Authors: Lessa, F. C., Mu, Y., Bamberg, W. M., Beldavs, Z. G., Dumyati, G. K., Dunn, J. R., Farley, M. M., Holzbauer, S. M., Meek, J. I., Phipps, E. C., Wilson, L. E., Winston, L. G., Cohen, J. A., Limbago, B. M., Fridkin, S. K., Gerding, D. N., & McDonald, L. C.
Affiliations: National Center for Emerging and Zoonotic Infectious Diseases (US)
Colorado Department of Public Health and Environment (US)
Oregon Health Authority (US)
University of Rochester Medicine (US)
Tennessee Department of Health (US)
Emory University (US)
Office of Readiness and Response (US)
Yale University (US)
University of New Mexico (US)
Maryland Department of Health (US)
University of California, San Francisco (US)
Loyola University Chicago (US)
ORCID: Lessa, Fernanda C.
Mu, Yi
Bamberg, Wendy M.
Dumyati, Ghinwa K.
Dunn, John R.
Farley, Monica M.
Holzbauer, Stacy M.
Meek, James I.
Phipps, Erin C.
Wilson, Lucy E.
Fridkin, Scott K.
Gerding, Dale N.
McDonald, L. Clifford
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2015-02-26
Volume: 372
Issue: 9
Pages: 825-834
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1408913
PMC: PMC10966662
OpenAlex: W2071054182
Cited by: 2,641
References: 44
Citations by year: 2026: 94 · 2025: 111 · 2024: 120 · 2023: 150 · 2022: 176 · 2021: 225 · 2020: 328 · 2019: 382 · 2018: 356 · 2017: 323 · 2016: 262 · 2015: 108
FWCI: 270.42
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
Locations: New England Journal of Medicine (publishedVersion, other-oa)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Maryland Shared Open Access Repository (USMAI Consortium) (submittedVersion, public-domain)
eScholarship (California Digital Library) (submittedVersion)
Digital Repository at the University of Maryland (University of Maryland College Park) (public-domain)
Funders: National Institutes of Health (CC999999)
Centers for Disease Control and Prevention
Topics: Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
Keywords: Clostridium difficile infection, incidence, nosocomial infections, community-associated infections, recurrence, mortality, NAP1 strain, molecular typing, pulsed-field gel electrophoresis
MeSH terms: Adolescent, Adult, Aged, Child, Child, Preschool, Clostridium Infections, Cross Infection, Female, Humans, Infant, Male, Middle Aged, Population Surveillance, Recurrence, United States, Bacterial Typing Techniques, Incidence, Clostridioides difficile, Electrophoresis, Gel, Pulsed-Field, Age Distribution, Sex Distribution

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