Clostridium difficile infection in rural Ontario: a retrospective multisite population-based study

Area of Science:

• Infectious Diseases
• Epidemiology
• Public Health

Background:

• Assessing the prevalence and risk factors of Clostridium difficile infections (CDI) in a defined population.
• Investigating CDI in both inpatient and outpatient settings within a specific region.

Purpose of the Study:

• To determine the incidence of CDI in a population-based study.
• To identify key risk factors associated with CDI, including antibiotic use and healthcare exposure.

Main Methods:

• Retrospective, population-based study utilizing laboratory data over a two-year period.
• Inclusion of data from three rural hospital laboratories serving distinct catchment areas.
• Collection of demographic and infection-specific data, including antibiotic history and healthcare facility stays.

Main Results:

• An estimated crude annual CDI rate of 24.3 per 100,000 population was observed.
• Nearly half (47.1%) of all CDI cases were diagnosed in outpatients.
• Antibiotic use (within 90 days) and hospital admission were significant risk factors, accounting for 47.1% of cases.

Conclusions:

• The incidence of CDI in this study is comparable to urban estimates, emphasizing its widespread nature.
• The substantial proportion of outpatient CDI cases underscores the importance of recognizing CDI as a serious condition outside of hospitals.
• Continued focus on antibiotic stewardship is crucial, given the high prevalence of prior antibiotic exposure among infected patients.