Volume 31, Number 6—June 2025
Research
Characterization of Adult and Pediatric Healthcare-Associated and Community-Associated Clostridioides difficile Infections, Canada, 2015–2022
, Anada Silva, Kelly B. Choi, Cassandra Lybeck, George R. Golding, Romeo Hizon, Sean Ahmed, Nicole Anderson, Suzanne Bakai-Anderson, Blanda Chow, Ian Davis, Meghan Engbretson, Gerald A. Evans, Charles Frenette, Matthew Garrod, Jennie Johnstone, Kevin C. Katz, Pamela Kibsey, Joanne M. Langley, Jenine Leal, Jenna Leamon, Bonita E. Lee, Diane Lee, Yves Longtin, Dominik Mertz, Jessica Minion, Ericka Oates, Michelle Science, Jocelyn A. Srigley, Kathryn N. Suh, Nisha Thampi, Reena Titoria, Kristen Versluys, Alice Wong, Jeannette L. Comeau, and Susy S. Hota
Table 1
Characteristics of adult and pediatric healthcare-associated Clostridioides difficile infections, Canada, 2015–2022*
| Characteristics | Overall, n = 22,627 | Adult cases, n = 21,405 | Pediatric cases, n = 1,222 | p value† |
|---|---|---|---|---|
| Median age, y (IQR) |
69 (56–80) |
70 (59–81) |
7 (3–13) |
|
| Sex | 0.024 | |||
| F | 10,994/22,625 (49) | 10,445/21,404 (49) | 549/1,221 (45) | |
| M |
11,631/22,625 (51) |
10,959/21,404 (51) |
672/1,221 (55) |
|
| Median days from admission to infection (IQR) | 10 (4–21) | 10 (5–21) | 7 (2–15) | <0.001 |
| Median length of stay, d (IQR) |
14 (7–23) |
15 (9–24) |
9 (5–18) |
<0.001 |
| Treatment | NA | |||
| Metronidazole | 6,377/18,907 (34) | 5,818/17,947 (32) | 559/960 (58) | |
| Vancomycin | 10,876/18,907 (58) | 10,588/17,947 (59) | 288/960 (30) | |
| Metronidazole and vancomycin | 982/18,907 (5.2) | 957/17,947 (5.3) | 25/960 (2.6) | |
| Fidaxomicin | 22/18,907 (0.1) | 22/17,947 (0.1) | 0/960 (0) | |
| Other | 186/18,907 (1.0) | 170/17,947 (0.9) | 16/960 (1.7) | |
| No treatment | 464/18,907 (2.5) | 392/17,947 (2.2) | 72/960 (7.5) | |
| FMT referral |
17/9,825 (0.2) |
17/9,318 (0.2) |
0/507 (0) |
>0.9 |
| 30-day outcomes‡ | ||||
| Loop ileostomy§ | 14/2,413 (0.6) | 14/1,816 (0.8) | 0/597 (0) | 0.028 |
| All-cause mortality | 416/4,429 (9.4) | 399/3,454 (12) | 17/975 (1.7) | <0.001 |
| Severe outcome¶ | 205/4,232 (4.8) | 180/3,270 (5.5) | 25/962 (2.6) | <0.001 |
| ICU admission for CDI complications | 73/4,448 (1.6) | 61/3,477 (1.8) | 12/971 (1.2) | 0.3 |
| Colectomy | 62/4,296 (1.4) | 50/3,329 (1.5) | 12/967 (1.2) | 0.5 |
| CDI-attributable death |
99/405 (24) |
98/388 (25) |
1/17 (5.9) |
0.084 |
| CDI recurrence# | ||||
| Recurrence | 223/2,709 (8.2) | 205/2,514 (8.2) | 18/195 (9.2) | 0.6 |
| Median days from primary infection to recurrence (IQR) | 29 (21–40) | 29 (21–41) | 26 (22–30) | 0.4 |
| Recurrence length of stay, d (IQR) | 10 (6–19) | 10 (6–16) | 30 (30–30) | 0.2 |
| Recurrence FMT referral | 0/81 | 0/79 | 0/2 | NA |
| Recurrence loop ileostomy | 1/81 (1.2) | 1/78 (1.3) | 0/3 | >0.9 |
| Recurrence all-cause mortality | 16/189 (8.5) | 16/177 (9.0) | 0/12 | 0.6 |
| Recurrence severe outcome¶ | 8/186 (4.3) | 8/174 (4.6) | 0/12 | >0.9 |
| ICU admission for recurrent CDI complications | 3/198 (1.5) | 3/185 (1.6) | 0/13 | >0.9 |
| Recurrence-attributable death | 5/16 (31) | 5/16 (31) | 0 | NA |
| Recurrence colectomy | 1/196 (0.5) | 1/183 (0.5) | 0/13 | >0.9 |
*Values are no. cases/no. in category (%) except as indicated. Denominators for individual case characteristic vary because missing or unknown values were excluded from the analysis. Bold font indicates statistical significance. CDI, C. difficile infection; FMT, fecal microbiota transplant; ICU, intensive care unit; IQR, interquartile range; NA, not applicable. †p value determined by Wilcoxon rank-sum test, Fisher exact test, or Pearson χ2 test. ‡Outcome data were collected during March–April of each calendar year for adult patients and year-round for pediatric patients. §Loop ileostomy added in 2018. ¶Severe outcome was defined as CDI-attributable admission to an intensive care unit, colectomy, or death within 30 d of positive C. difficile specimen where CDI was the cause of death or contributed to death. #Adult and pediatric cases identified during March–April of each calendar year were followed prospectively for 8 weeks for recurrence.