2014 Annual Report for the Emerging Infections Program for Clostridium difficile Infection

2014 Annual Report Print Version [PDF – 544 KB]

In 2014, a total of 16,345 cases of C. difficile infection (CDI) were reported to the Emerging Infections Program (EIP) in 35 counties in 10 US states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee).

The overall distribution of EIP CDI cases and crude incidence by selected demographic factors and epidemiologic classification are presented in Table 1. Data in this report are not intended to be directly compared to annual reports from other years, and should not be used to determine annual changes in EIP CDI incidence rates because single year calculations do not account for changes in testing practices by reporting facilities.

Table 1. Reported Number of CDI Cases and Crude Incidence by Sex, Age Group, Race, and Epidemiologic Classification Among the 10 EIP Sites^a

1. The epidemiologic classification was statistically imputed for 0.6% of the observed CDI cases, and race was statistically imputed for 18.8% of the observed CDI cases. The weighted frequency of cases in Colorado and Georgia was based on 33% random sampling.
2. A CDI case was classified as community-associated if the C. difficile-positive stool specimen was collected on an outpatient basis or within 3 days after hospital admission in a person with no documented overnight stay in a healthcare facility in the preceding 12 weeks. All CDI cases that do not meet the aforementioned criteria were classified as healthcare-associated.
3. Cases per 100,000 persons.

Laboratory Characterization of C. difficile Isolates

In 2014, a total of 1,123 C. difficile isolates were submitted to CDC for further analysis. The total number of isolates received from each site ranged from 13 to 252, with a median of 102. The majority of the isolates (89%) were collected in metropolitan areas.

Among all isolates submitted, 134 distinct ribotypes were detected. Ribotype 106 was the most common ribotype among community-associated C. difficile isolates, followed by 020, 002 and 027 (Table 2). Among healthcare-associated C. difficile isolates, ribotype 027 predominated, followed by 106, 002 and 014. (Table 3). A significant decrease in ribotype 027 occurred from 12% in 2013 to 7% in 2014 among community-associated C.difficile isolates. Similarly, ribotype 027 decreased from 24% in 2013 to 14% among healthcare-associated isolates of C. difficile.

Twenty-two percent of the isolates harbored a deletion in tcdC. Twenty-two percent of the isolates were binary toxin-positive, and among these, ribotypes 027, 078 and 019 predominated.

Table 2. Frequency of Ribotypes Among Community-Associated C. difficile Isolates, 2014 (n=619)

Table 3. Frequency of Ribotypes Among Healthcare-Associated C. difficile Isolates, 2014 (n=504)