Comparing the epidemiology of community- and hospital-associated Clostridium difficile infections in Northern Ireland, 2012-2016: a population data linkage and case-case study

Anna Maisa, Gillian Ross, Neville Verlander, Derek Fairley, Declan Bradley, Lynsey Patterson

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The burden of community-associated Clostridium difficile infection (CA-CDI) has increased. We aimed to describe the epidemiology of CA-CDI to inform future interventions. We used population-based linked surveillance data from 2012-2016 to describe socio-demographic factors, ribotype and mortality for all CA (n=1303) and hospital-associated (HA, n=1356) CDI. For 483 community-onset (CO) CA-CDI and 287 COHA-CDI cases a questionnaire on risk factors was completed and we conducted a case-case study using logistic regression models for univariate and multivariable analysis. CA-CDI cases had lower odds of being male (AOR 0.71, 95% CI 0.58-0.87; p<0.001), and higher odds of living in rural rather than urban settlement (AOR 1.5, 95% CI 1.1-2.1; p=0.05) compared to HA-CDI cases. The distribution of ribotypes was similar in both groups with RT078 being most prevalent. CDI-specific death was lower in CA-CDI than HA-CDI (7% vs. 11%, p<0.001). COCA-CDI had lower odds of having had an outpatient appointment in the previous four weeks compared to COHA-CDI (AOR 0.61; 95% CI 0.41-0.9, p=0.01) and lower odds of being in a care home or hospice when compared to their own home, than COHA-CDI (AOR 0.66; 95% CI 0.45-0.98 and AOR 0.35; 95% CI 0.13-0.92, p=0.02). Exposure to gastric acid suppressants (50% in COCA-CDI and 55% in COHA-CDI) and antimicrobial therapy (18% in COCA-CDI and 20% in COHA-CDI) prior to CDI was similar. Our analysis of community-onset cases suggests that other risk factors for COHA-CDI may be equally important for COCA-CDI. Opportunities to safely reduce antibiotic and gastric acid suppressants use should be investigated in all healthcare settings.
Original languageEnglish
Article numbere141
Number of pages8
JournalEpidemiology and Infection
Early online date13 Mar 2019
Publication statusEarly online date - 13 Mar 2019


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