Burden of Clostridium difficile infection in the United States

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

Research output: Contribution to journalArticlepeer-review

1415 Scopus citations


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

Original languageEnglish (US)
Pages (from-to)825-834
Number of pages10
JournalNew England Journal of Medicine
Issue number9
StatePublished - Feb 26 2015
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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