C. difficile Infections
Total Number of Infections in EIP Sites
14,312
in 2023
Infections by Epidemiologic Class
- Community-associated:
- 53%
- Healthcare-associated:
- 47%
Infections by Race
- White, non-Hispanic:
- 63%
- Black, non-Hispanic:
- 19%
- A/PI, non-Hispanic:
- 4%
- AI/AN/MR, non-Hispanic:
- 2%
- Hispanic:
- 12%
CDI Data Profile (EIP)
C. difficile Infections
When a person takes antibiotics, good bacteria in the gut are destroyed for several months. During this time, patients can get sick from Clostridioides difficile (C. difficile, or CDI), bacteria that often cause serious or even deadly diarrhea. Older adults and people who have illnesses or conditions requiring prolonged use of antibiotics are at greater risk of acquiring this disease, particularly within a healthcare setting. Preventing C. difficile infections is a CDC priority.
Clostridioides difficile Infections in EIP Sites
Frequency and Incidence of CDI in 10 EIP SITES (2011-2023)
Subcategories may not add to total due to rounding.
CDI Infections — All Cases — Total — Number of Cases
Note: Epidemiologic classification (epi class): A CDI case is classified as community-associated (CA) if the Clostridioides 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 are classified as healthcare-associated (HA). Surveillance areas have changed over time.
Clostridioides difficile Strain Types in EIP Sites
Most Common Clostridioides difficile Sequence Types by Epidemiologic Classification in 10 EIP Sites (2018-2022)*
*Data displayed reflects multi-locus sequence typing (MLST), which began in 2018, different than the graph below which represents ribotype data. Isolate data are currently available through 2022. Additional years of data will be included as they become available.
CDI Sequence Types — All Cases
Most Common Clostridioides difficile Ribotypes by Epidemiologic Classification in 10 EIP Sites (2012-2018)*
*Ribotype data are only available through 2018, when the strain typing method changed to use of MLST.
CDI Ribotypes — All Cases
Note: Epidemiologic classification (epi class): A CDI case is classified as community-associated (CA) if the Clostridioides 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 are classified as healthcare-associated (HA). Surveillance areas have changed over time.
Clostridioides difficile Multi-Locus Sequence Types (STs) and Their Associated Ribotypes
A collection of isolates representing common ribotypes observed from previous EIP surveillance years underwent whole genome sequencing and multi-locus sequence typing (MLST). Some STs corresponded to a single ribotype and some to multiple and/or overlapping STs. The table represents a crosswalk to assist with evaluation of previous ribotype data for the top five STs observed each year. This table will be updated as new STs are added and as more associated PCR ribotype data is available.
| MLST (ST) | Associated PCR Ribotype(s) |
|---|---|
| ST1 | 027, 036, A75 |
| ST2 | 014, 020, 076, 077, 207, A27, A30 |
| ST3 | 001_072, 009, 305 |
| ST8 | 002 |
| ST14 | 014, 077, 207, A27 |
| ST34 | 056 |
| ST42 | 106, 002, 077 |
| ST53 | 024, 103, 351 |
| ST110 | 014, 020, 076, 154, 207, A27 |
Footnotes
- From 2012-2018, Clostridioides difficile strain typing was performed using capillary-based PCR-ribotyping and results were analyzed against a library of standard profiles using BioNumerics (Fawley WN, Knetsch CW, MacCannell DR et al. Development and validation of an internationally-standardized, high-resolution capillary gel-based electrophoresis PCR-ribotyping protocol for Clostridioides difficile. PLoS One. 2015;10(2):e0118150.). Starting in 2018, MLST was used to perform C. difficile strain typing (Clostridioides difficile | PubMLST). The MLST data were derived from whole genome sequencing of C. difficile isolates.
- Starting in 2023, Bayesian Improved Surname Geocoding (BISG) was used to impute missing race/ethnicity (Using the Census Bureau's Surname List to Improve Estimates of Race/Ethnicity and Associated Dispari… ). Race/ethnicity was considered missing if a patient had unknown ethnicity (regardless of reported race) or if a patient had unknown race and was not Hispanic or Latino. BISG applies Bayes' Theorem to calculate a patient's probability of identifying with each racial/ethnic group given their surname and home census tract or county. Probabilities for patients with known race/ethnicity were set to 1 for their reported race/ethnicity group and 0 for all other racial/ethnic groups. Race/ethnicity-stratified case counts were calculated by summing the probabilities for each racial/ethnic group. Note that a small proportion of patients with missing race/ethnicity who are multiracial (Asian and Native Hawaiian/Other Pacific Islander) may have been imputed as Non-Hispanic or Latino – Asian and/or Native Hawaiian/Other Pacific Island using the BISG method, which does not distinguish between these two racial/ethnic groups.
- The following footnote provides definitions for all abbreviated terms in the hero cards, A/PI (Asian and/or Native Hawaiian/Other Pacific Islander) and AI/AN/MR (American Indian or Alaska Native or Multiracial).