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Updated: Aug 14, 2026
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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
Characterization of Clostridioides difficile in the U.S. Military, 2016-2024
Ashley M Foulkrod1, Thomas A Beltran2, Sarah M Ordway1
1Department of Internal Medicine, Womack Army Medical Center, Fort Bragg, NC 28310, United States.
Military Medicine
|August 13, 2026
Summary
Clostridioides difficile infection (CDI) incidence in active-duty service members (ADSMs) saw a 43.5% annual decline from 2016-2024. Women and older ADSMs faced higher risks, highlighting the need for targeted prevention strategies.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Clostridioides difficile (C. difficile) infection (CDI) poses a significant public health challenge due to its prevalence and associated morbidity.
- Active-duty service members (ADSMs) represent a unique population with distinct risk factors for CDI, including frequent travel and antibiotic exposure.
- Understanding the evolving epidemiology of CDI within this cohort is crucial for effective public health interventions.
Purpose of the Study:
- To update the epidemiology of CDI among ADSMs in the United States from 2016 to 2024.
- To identify demographic, occupational, and clinical factors associated with CDI risk in this population.
- To analyze trends in CDI incidence and treatment within the military cohort.
Main Methods:
- A retrospective analysis of 2.7 million ADSMs from January 2016 to December 2024 using the Medical Assessment and Readiness System.
- Identification of CDI cases through ICD-10 codes, with extraction of relevant sociodemographic, occupational, and clinical data.
- Statistical analysis to determine incidence rates, risk ratios, and trends over the study period.
Main Results:
- A total of 2,489 CDI cases were identified, with an overall incidence of 21.4 per 100,000 person-years.
- Annual CDI cases decreased by 43.5% from 2016 to 2024, with higher incidence in the Army and Air Force.
- Women (RR, 1.7) and ADSMs over 50 (RR, 6.0) exhibited increased risk. Vancomycin was the predominant treatment.
Conclusions:
- CDI incidence in ADSMs, while modest, is clinically significant, with notable risk elevation in women and variations across service branches.
- Despite an overall increase compared to prior research, annual CDI incidence has declined within the observed period.
- Associated gastrointestinal diagnoses and the need for targeted prevention, antimicrobial stewardship, and structured post-CDI care pathways are emphasized.
