Clostridium difficile (C. difficile) Surveillance - New Haven County

Purpose

The Emerging Infections Program (EIP) Clostridium difficile infection (CDI) surveillance is being conducted in seven EIP sites throughout the United States . Clostridium difficile is an anaerobic, spore-forming, gram positive bacillus that produces two pathogenic toxins: A and B. CDI ranges in severity from mild diarrhea to fulminant colitis and death. The primary risk factor for development of CDI in healthcare settings is recent antimicrobial use. Other risk factors for CDI acquisition in these settings are age greater than 65 years, severe underlying illness, intensive care unit admission, nasogastric intubation, use of Proton Pump Inhibitors and longer duration of hospital stay. Transmission of C. difficile occurs primarily in healthcare facilities, where environmental contamination by C. difficile spores and exposure to antimicrobial drugs are common. No longer limited to healthcare environments, community-associated CDI is the focus of increasing attention. The sources of C. difficile and the risks for developing CDI in previously thought to be low-risk community populations are not well defined. The possibility of foodborne transmission from animal source has been suggested. Further studies are needed to understand the implications of isolating C. difficile from meat and potentially from food producing animals. The purpose of the surveillance system is to determine the population-based incidence of community-and healthcare-associated CDI among participating EIP sites; characterize C. difficile strains that are responsible for CDI in the population under surveillance with a focus on strains from community-associated cases; and describe the epidemiology of CDI and generate hypotheses for future research activities using EIP CDI surveillance infrastructure.

Goals & Objectives

• Determine the population-based incidence of community- and healthcare-associated CDI among participating EIP sites.
• Characterize C. difficile strains that are responsible for CDI in the population under surveillance with a focus on strains from community-associated cases.
• Describe the epidemiology of community- and healthcare-associated CDI and generate hypotheses for future research activities using EIP CDI surveillance infrastructure.

Activities

• In Connecticut , CDI laboratory-based surveillance will be conducted for all toxin-positive C. difficile cases that reside in New Haven and Waterbury areas. A list of all positive C. difficile tests will be evaluated to determine individual cases and classify the cases as either Community Onset (Health Care Associated or Community Associated) or Health Care Onset.
• Each presumptive community-associated case, each community-onset healthcare associated case, and a 10% sample of health-care onset cases will also require full chart review to complete the case report form. Each presumptive community-associated case of CDI will also be interviewed.
• Select laboratories will save stool samples on all cases of CDI for further laboratory evaluation including culture and toxinotype testing.

Presentations

Soeters M, Shrestha A, Marcus R, Hurd S. Pilot Study: Surveillance of Clostridium difficile Infection in New Haven County, Connecticut, poster presented at the Connecticut Public Health Association Annual meeting, November 14, 2008, Westbrook, CT.

AD Thompson, M Bonkosky, D MacCannell, G Dumyati, G Hannett, V Stevens, M Soeters, LH Gould, C Long, B Limbago. Characterization of community- and healthcare-associated Clostridium difficile from two states,poster presented at Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 2009, San Francisco, CA.

Related Links

Centers for Disease Control and Prevention

Project Contact Person

Michelle Soeters, MPH
Project Coordinator
Yale Emerging Infections Program
One Church Street, 7th floor
New Haven, CT 06510
(203) 764-4276

Emerging Infections Program
Yale School of Public Health
1 Church Street, 7th Floor
New Haven, CT 06510
Phone: (203) 764-4360
Fax: (203) 764-4357