Characterization of Adult and Pediatric Healthcare-Associated and Community-Associated Clostridioides difficile Infections, Canada
Reviewed by Jen Cihlar, DO, Vanderbilt University
Bottom line: Over an 8-year study period rates of HA CDI in adults and pediatrics reduced with robust reduction in pediatric CA CDI. Also, RT 106 replaced RT027 as most common strain. RT027 was associated with more cases in adults, severe CDI and severe outcomes which have also been seen globally.
Silva and colleagues found that of the 30,824 inpatient Clostridioides difficile infection (CDI) cases reported in the Canadian Nosocomial Infection Surveillance Program hospitals between 2015–2022, adult comprised of 94.9% (73% hospital acquired (HA)) of cases with pediatric cases the remaining 5.1% (78% HA). Over the study period there were comparable reductions in HA CDI between adult and pediatric cases (19.9% vs 29.6%) with a notably larger reduction of 58.3% in pediatric community acquired (CA) CDI compared to stable adult CA CDI rates. Molecular analysis noted a dynamic and heterogeneous ribotype (RT) population with RT106 predominating in both adult and pediatric patients (comprising 12-17% of all cases analyzed). More adult than pediatric patients experienced a severe outcome (CDI-attributable admission to an intensive care unit, colectomy, or death <30 days after first C. difficile–positive specimen) for HA CDI (12% vs. 1.7%; p<0.001), no significant difference in severe outcome for CA CDI between adult and pediatric cases. Multivariable analysis revealed RT027 was associated more with adults, severe CDI, and severe outcomes. However, it was found over time RT027 prevalence in Canada decreased substantially among adults (21.9% in 2015 to 3.2% in 2022) and remained relatively low in pediatric inpatients (fluctuated but average 3.2% throughout the study), which the authors state mirror decreases in RT027 prevalence observed in North America, the United Kingdom, and elsewhere based on several studies.
Reference:
Du T, Silva A, Choi KB, et al. Characterization of Adult and Pediatric Healthcare-Associated and Community-Associated Clostridioides difficile Infections, Canada, 2015–2022. Emerging Infectious Diseases. 2025;31(6):1109-1120. doi:10.3201/eid3106.250182.