Gastroenterologie
a hepatologie

Changing epidemiology of Clostridioides difficile infection – increasing number of community-acquired forms and infections in children

Robert Rosoľanka ^{Orcid.org  1}, Martin Schnierer ^{Orcid.org  2}, Martin Sučík¹, Katarína Šimeková¹, Peter Bánovčin ^{Orcid.org  3}

+ Affiliation
¹ Klinika infektológie a cestovnej medicíny, JLF UK a UN Martin, Slovenská republika
² Interná klinika gastroenterologická JLF UK a UN Martin, Slovenská republika
³ Klinika detí a dorastu JLF UK a UN Martin

Summary

Clostridioides difficile colitis has long been considered an infection associated with hospitalization and concomitant antibiotic treatment. However, the increasing number of community cases in recent years has led to a reassessment of the traditional understanding of its epidemiological characteristics. In addition, community-associated forms have been reported many times in children, young adults, or people without comorbidities and with a negative history of antibiotic use in the pre-disease period. These groups have traditionally been considered low risk for the development of the infection. Thus, many studies have naturally investigated the impact of asymptomatic Clostridioides difficile carriers, including neonates and infants, on the transmission of the causative agent in the community. The prevalence of this bacterium in animals, in food and in the environmental setting has also been the subject of research. The goal was to elucidate the role of these factors in the spread of the agent in community settings. In this article, we summarize the current knowledge on confirmed and potential risk factors for community-acquired Clostridioides difficile infection, together with the results of studies examining patient characteristics. We also provide information on the issue of Clostridioides difficile infection in the paediatric population, which is closely intertwined with the community-acquired form of the infection.

Keywords

asymptomatic carrier state, Clostridioides difficile, epidemiology, community-acquired infections

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Heinlen L, Ballard JD. Clostridium difficile Infection. The American J Med Sci 2010; 340(3): 247–252. doi: 10.1097/maj.0b013e3181e939d8.
2. Sandhu BK, McBride SM. Clostridioides difficile. Trends Microbiol 2018; 26(12): 1049–1050. doi: 10.1016/j.tim.2018.09.004.
3. Lim SC, Knight DR, Riley TV. Clostridium difficile and One Health. Clin Microbiol and Infect 2020; 26(7): 857–863. doi: 10.1016/j.cmi.2019.10.023.
4. Kyne L, Merry C, O’Connell B et al. Community-acquired Clostridium difficile infection. J Infect 1998; 36(3): 287–288. doi: 10.1016/s01 63-4453(98)94207-4.
5. Riley TV, Cooper M, Bell B et al. Community-Acquired Clostridium difficile-Associated Diarrhea. Clin Infect Dis 1995; 20(Suppl.): S263–S265. doi: 10.1093/clinids/20.supplement_2.s263.
6. Hirschhorn LR, Trnka YM, Onderdonk AB et al. Epidemiology of Community-Acquired Clostridium difficile-Associated Diarrhea. J Infect Dis 1994; 169(1): 127–133. doi: 10.1093/ infdis/169.1.127.
7. Thornton CS, Rubin JE, Greninger AL et al. Epidemiological and genomic characterization of community-acquired Clostridium difficile infections. BMC Infect Dis 2018; 18(1): 443. doi: 10.1186/s12879-018-3337-9.
8. Fu Y, Luo Y, Grinspan AM. Epidemiology of community-acquired and recurrent Clostridioides difficile infection. Ther Adv Gastroenterol 2021; 14: 175628482110162. doi: 10.1177/17562848211016248.
9. Mora Pinzon MC, Buie R, Liou J et al. Outcomes of Community and Healthcare-onset Clostridium difficile Infections. Clin Infect Dis 2018; 68(8): 1343–1350. doi: 10.1093/cid/ciy715.
10. Viprey VF, Davis GL, Benson AD et al. A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018. Euro Surveill 2022; 27(26): 2100704. doi: 10.2807/1560-7917.es.2022.27.26.2100704.
11. Penit A, Bemer P, Besson J et al. Community-acquired Clostridium difficile infections. Médecine et Maladies Infectieuses 2016; 46(3): 131–139. doi: 10.1016/j.medmal.2016.01.007.
12. Khanna S, Pardi DS, Aronson SL et al. Outcomes in community-acquired Clostridium difficile infection. Alimentary Pharmacol Ther 2012; 35(5): 613–618. doi: 10.1111/j.1365-2036. 2011.04984.x.
13. Chitnis AS, Holzbauer SM, Belflower RM et al. Epidemiology of Community-Associated Clostridium difficile Infection, 2009 Through 2011. JAMA Int Med 2013; 173(14): 1359. doi: 10.1001/jamainternmed.2013.7056.
14. McDonald LC, Gerding DN, Johnson S et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018; 66(7): 987–994. doi: 10.1093/cid/ciy149.
15. Hensgens MPM, Keessen EC, Squire MM et al. Clostridium difficile infection in the community: a zoonotic disease? Clin Microbiol Infect 2012; 18(7): 635–645. doi: 10.1111/j.14 69-0691.2012.03853.x.
16. Khanna S, Gupta A. Community-acquired Clostridium difficile infection: an increasing public health threat. Infection and Drug Resistance 2014 [online]. doi: 10.2147/idr.s46780.
17. Kim G, Zhu NA. Community-acquired Clostridium difficile infection. Can Fam Physician 2017; 63(2): 131–132.
18. Riggs MM, Sethi AK, Zabarsky TF et al. Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic Clostridium difficile Strains among Long-Term Care Facility Residents. Clin Infect Dis 2007; 45(8): 992–998. doi: 10.1086/521854.
19. Zhang J, Chen L, Gomez-Simmonds A et al. Antibiotic-Specific Risk for Community-Acquired Clostridioides difficile Infection in the United States from 2008 to 2020. Antimicrob Agents Chemother 2022; 66(12): e0112922. doi: 10.1128/aac.01129-22.
20. Vervoort J, Xavier BB, Stewardson A et al. Metagenomic analysis of the impact of nitrofurantoin treatment on the human faecal microbiota. J Antimicrob Chemother 2015; 70(7): 1989–1992. doi: 10.1093/jac/dkv062.
21. Beneš J. Antibiotika: systematika, vlastnosti, použití. Praha: Grada Publishing 2018.
22. Rabold D, Espelage W, Abu Sin M et al. The zoonotic potential of Clostridium difficile from small companion animals and their owners. PLoS ONE 2018; 13(2): e0193411. doi: 10.1371/journal.pone.0193411.
23. Predrag S, Kuijper EJ, Nikola S et al. Recurrent community-acquired Clostridium (Clostridioides) difficile infection in Serbian children. Eur J Clinical Microbiol Infect Dis 2020; 39(3): 509–516. doi: 10.1007/s10096-019-03751-4.
24. Khanna S, Baddour LM, Huskins WC et al. The Epidemiology of Clostridium difficile Infection in Children: A Population-Based Study. Clin Infect Dis 2013; 56(10): 1401–1406. doi: 10.1093/cid/cit075.
25. Sandora TJ, Fung M, Flaherty K et al. Epidemiology and Risk Factors for Clostridium difficile Infection in Children. Pediatr Infect Dis J 2011; 30(7): 580–584. doi: 10.1097/inf.0b013e31820bfb29.
26. González-Del Vecchio M, Álvarez-Uria A, Marin M et al. Clinical Significance of Clostridium difficile in Children Less Than 2 Years Old: A Case-Control Study. Pediatr Infect Dis J 2016; 35(3): 281–285. doi: 10.1097/INF.0000000000001008.
27. Valentini D, Vittucci AC, Grandin A et al. Coinfection in acute gastroenteritis predicts a more severe clinical course in children. Eur J Clin Microbiol Infect Dis 2013; 32(7): 909–915. doi: 10.1007/s10096-013-1825-9.
28. Zárubová K. Dificlir – fidaxomicin – an effective treatment option for C. difficile infections in children. Gastroenterol Hepatol 2022; 76(6): 515–516. doi: 10.48095/ccgh2022515.
29. Beneš J, Stebel R, Musil V et al. Aktualizovaný doporučený postup pro léčbu nemocných s kolitidou vyvolanou Clostridioides difficile. Doporučený postup Společnosti infekčního lékařství ČLS JEP. 2022 [online]. Dostupné z: https: //www. infektologie.cz/zprava22-39.htm.
30. Alshaikh FS, Godman B, Sindi ON et al. Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID- -19: A systematic review and meta-analysis. PLoS One 2022; 17(8): e0272375. doi: 10.1371/journal.pone.0272375.
31. Karami Z, Knoop BT, Dofferhoff ASM et al. Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands. Infect Dis 2020; 53(2): 102–110. doi: 10.1080/23744235.2020.1839672.
32. Langford BJ, So M, Raybardhan S et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27(4): 520–531. doi: 10.1016/ j.cmi.2020.12.018.
33. Langford BJ, So M, Raybardhan S et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020; 26(12): 1622–1629. doi: 10.1016/j.cmi.2020.07.016.
34. European Centre for Disease Prevention and Control. European Surveillance of Clostridioides (Clostridium) difficile infections. Surveillance protocol version 2.4. Stockholm: ECDC; 2019. doi: 10.2900/60304.