Recurrence of Clostridium difficile infection in the Western Australian population

Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or di...

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Bibliographic Details
Published in:Epidemiology and infection 2019-01, Vol.147, p.e153-e153, Article e153
Main Authors: Alfayyadh, M, Collins, D A, Tempone, S, McCann, R, Armstrong, P K, Riley, T V, Cook, A
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Clostridium difficile - classification
Clostridium difficile - genetics
Clostridium difficile - isolation & purification
Clostridium Infections - epidemiology
Female
Genotype
Humans
Male
Middle Aged
Original Paper
Recurrence
Ribotyping
Time Factors
Western Australia - epidemiology
Young Adult
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Summary:Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or different strains of C. difficile. An interval of 8 weeks after index infection is commonly used to classify recurrent CDI episodes. We assessed strains of C. difficile in a sample of patients with recurrent CDI in Western Australia from October 2011 to July 2017. The performance of different intervals between initial and subsequent episodes of CDI was investigated. Of 4612 patients with CDI, 1471 (32%) were identified with recurrence. PCR ribotyping data were available for initial and recurrent episodes for 551 patients. Relapse (recurrence with same ribotype (RT) as index episode) was found in 350 (64%) patients and reinfection (recurrence with new RT) in 201 (36%) patients. Our analysis indicates that 8- and 20-week intervals failed to adequately distinguish reinfection from relapse. In addition, living in a non-metropolitan area modified the effect of age on the risk of relapse. Where molecular epidemiological data are not available, we suggest that applying an 8-week interval to define recurrent CDI requires more consideration.
ISSN:0950-2688
1469-4409
DOI:10.1017/S0950268819000499