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Volume 28, Number 6—June 2022

Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015–2019

Tim Du1, Kelly B. Choi1, Anada Silva, George R. GoldingComments to Author , Linda Pelude, Romeo Hizon, Ghada N. Al-Rawahi, James Brooks, Blanda Chow, Jun C. Collet, Jeannette L. Comeau, Ian Davis, Gerald A. Evans, Charles Frenette, Guanghong Han, Jennie Johnstone, Pamela Kibsey, Kevin C. Katz, Joanne M. Langley, Bonita E. Lee, Yves Longtin, Dominik Mertz, Jessica Minion, Michelle ScienceComments to Author , Jocelyn A. Srigley, Paula Stagg, Kathryn N. Suh, Nisha Thampi, Alice Wong, and Susy S. Hota
Author affiliations: National Microbiology Laboratory, Winnipeg, Manitoba, Canada (T. Du, G.R. Golding, R. Hizon); Public Health Agency of Canada, Ottawa, Ontario, Canada (K.B. Choi, A. Silva, L. Pelude, J. Brooks); British Columbia Children’s Hospital, Vancouver, British Columbia, Canada (G.N. Al-Rawahi); Alberta Health Services, Calgary, Alberta, Canada (B. Chow); BC Children’s & Women’s Hospitals, Vancouver (J.C. Collet, J.A. Srigley); Dalhousie University, Halifax, Nova Scotia, Canada (J.L. Comeau); Queen Elizabeth II Health Sciences Centre, Halifax (I. Davis); Kingston Health Sciences Centre, Kingston, Ontario, Canada (G.A. Evans); McGill University Health Centre, Montréal, Quebec, Canada (C. Frenette); Provincial Infection Control Network, Vancouver (G. Han); Sinai Health, Toronto, Ontario, Canada (J. Johnstone); Royal Jubilee Hospital, Victoria, British Columbia, Canada (P. Kibsey); North York General Hospital, Toronto (K.C. Katz); IWK Health Centre, Halifax (J.M. Langley); Stollery Children’s Hospital, Edmonton, Alberta, Canada (B.E. Lee); Jewish General Hospital, Montréal (Y. Longtin); Hamilton Health Sciences, Hamilton, Ontario, Canada (D. Mertz); Regina General Hospital, Regina, Saskatchewan, Canada (J. Minion); The Hospital for Sick Children, Toronto (M. Science); Western Memorial Regional Hospital, Corner Brook, Newfoundland and Labrador, Canada (P. Stagg); The Ottawa Hospital, Ottawa (K.N. Suh); Childrens Hospital of Eastern Ontario, Ottawa (N. Thampi); Royal University Hospital, Saskatoon, Saskatchewan, Canada (A. Wong); University Health Network, Toronto (S.S. Hota)

Main Article

Table 1

Clinical and molecular characteristics of healthcare-associated and community-associated Clostridioides difficile infection among adults, Canada, 2015–2019*

Characteristics Healthcare-associated Community-associated All cases p value
Routine surveillance, no. (%)†
13,735 (74.4)
4,720 (25.6)

Patient characteristics
Age, y
Mean (SD) 68.3 (16.9) 64.4 (18.4) 67.3 (17.4) <0.001
Median (IQR) 70.0 (59.0–81.0) 67.0 (54.0–79.0) 70.0 (58.0–80.0) <0.001
Sex, no. (%)
F 6,747 (49.1) 2,645 (56.0) 9,392 (50.9) <0.001
6,988 (50.9)
2,075 (44.0)
9,063 (49.1)

Targeted surveillance, no. (%)‡
2,350 (76.2)
734 (23.8)

Clinical results and outcomes
Median (IQR) leukocyte count, × 109 cells/L 10.9 (23.0–33.0) 10.6 (6.9–15.7) 10.8 (7.1–16.0) NS
Median (IQR) albumin, g/L 26.0 (22.0–31.0) 28.0 (23.0–33.0) 27.0 (22.0–32.0) 0.0232
FMT, no. positive/no. tested (%)§ 11/3,645 (0.3) 4/1,557 (0.3) 15/5,202 (0.3) NS
Colectomy, no. positive/no. tested (%) 30/2,255 (1.3) 15/725 (2.1) 45/2,980 (1.5) NS
Loop ileostomy, no. positive/no. tested (%) 2/798 (0.3) 3/270 (1.1) 5/1,068 (0.5) NS
ICU admission, no. (%) n = 2,340 n = 733 n = 3,073
All cause 156 (6.7) 51 (7.0) 207 (6.8) NS
Due to complications of CDI 46 (2.0) 11 (1.5) 57 (1.9) NS
30-d mortality, no. (%) n = 2,302 n = 731
Death, all causes 263 (11.4) 53 (7.3) 316/3,033 (10.4) 0.0001
Death, attributable to CDI 69 (3.0) 17 (2.3) 86/3,019 (2.9) NS

*Missing or unknown values were excluded from the analysis. χ2 test was used to assess statistical significance for categorical variables; Student t test, or the Wilcoxon rank sum test was used for continuous variables. CDI, Clostridiodes difficile infection; FMT, fecal microbiota transplantation; ICU, intensive care unit; IQR, interquartile range; NS, not significant. †Patient characeristics data collected year-round.
‡Clinical results and outcome data are collected during a 2-month targeted surveillance period (March–April) each year except FMT where the data were collected year-around.
§FMT data collection started in 2018.

Main Article

1These authors contributed equally to this article.

Page created: April 01, 2022
Page updated: May 22, 2022
Page reviewed: May 22, 2022
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