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Incidence of Clostridioides difficile infections among young and middle-aged adults: Veterans Health Administration

  • Ellyn M. Russo (a1), Jennifer Kuntz (a2), Holly Yu (a3), Jeremy Smith (a1), Ronald George Hauser (a4) (a5), Yuliya Halchenko (a1) and Yinong Young-Xu (a1) (a6)...

Abstract

Objective:

Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.

Design/Setting:

A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.

Patients/Methods:

Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.

Results:

Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.

Conclusions:

The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence ( https://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

Author for correspondence: Ellyn M. Russo, Email: Ellyn. Russo@va.gov.

Footnotes

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PREVIOUS PRESENTATION: These data were presented at the 28th European Congress of Clinical Microbiology and Infectious Diseases on April 21, 2018, in Madrid, Spain: Russo E, Smith J, Kuntz J, Halchenko Y, Yu H, Young-Xu Y. Incidence of Clostridium difficile infections among Veterans Health Administration patients 18 to 64 years of age.

Footnotes

References

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