Abstract
Abstract : Reports of increased incidence and severity have renewed interest in the epidemiology of Clostridium difficile infection (CDI). This retrospective report summarizes trends for CDI for Department of Defense (DOD) and Department of the Navy (DON) beneficiaries from 2007-2013. CDI trends among both populations were similar and CDI incidence rates increased approximately 9.5% among all beneficiaries. Most notably, the increase occurred among beneficiaries with community-acquired (CA) CDI. For most DOD and DON beneficiaries, trends indicate that the vast majority of CDI were both acquired and identified in the community setting. The traditional risk factors (antibiotic use, ages 65 years and older and hospitalization) continue to be important to consider in the diagnostic evaluation of CDI. However, among all beneficiaries, the majority of CDI episodes were acquired in the community in ages ranging from 45 years and older. In addition, although most cases had an antibiotic prescribed in the 90 days before symptom onset, approximately 30% of beneficiaries did not have a history of antibiotic use. Therefore, providers should suspect CDI in any patient with acute inflammatory diarrhea including patients with no antibiotic use or healthcare facility exposures.
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