The Changing Epidemiology of Clostridioides difficile Infection

Clostridioides difficile infection (CDI) epidemiology has evolved over the past 3 decades. In the early 2000s, incidence and severity surged, driven by hypervirulent strains, extensive use of broad-spectrum antibiotics, an aging population, suboptimal infection-control practices, and highly sensitive molecular diagnostics. During the same period, community-associated CDI (CA-CDI) emerged affecting a different population. Recent optimization of infection prevention, antimicrobial stewardship, and multi-step diagnostic algorithms have helped curb hospital-acquired CDI. However, CA-CDI accounts for approximately half of all CDI cases and is rising. These trends underscore the need for continued surveillance, targeted prevention strategies, and enhanced access to effective treatments.