Y Xia1,2, M C Tunis3, C Frenette4, K Katz5, K Amaratunga6,7, S Rhodenizer Rose8, A House3, C Quach1,2,9,10. 1. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC. 2. Infection Prevention and Control, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC. 3. Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON. 4. Department of Laboratory Medicine, McGill University Health Centre, Montreal, QC. 5. North York General Hospital, Toronto, ON. 6. Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON. 7. Department of Medicine, Division of Infectious Diseases, University of Ottawa, Ottawa, ON. 8. Infection Prevention and Control Canada, Halifax, NS. 9. Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal, QC. 10. Department of Pediatric Laboratory Medicine, CHU Sainte-Justine, Montreal, QC.
Abstract
BACKGROUND: Two vaccines against Clostridioides difficile infections (CDI) are currently in phase III trials. To enable decision-making on their use in public health programs, national disease epidemiology is necessary. OBJECTIVES: To determine the epidemiology of hospital-acquired CDI (HA-CDI) and community-associated CDI (CA-CDI) in Canada using provincial surveillance data and document discrepancies in CDI-related definitions among provincial surveillance programs. METHODS: Publicly-available CDI provincial surveillance data from 2011 to 2016 that distinguished between HA-CDI and CA-CDI were included and the most common surveillance definitions for each province were used. The HA-, CA-CDI incidence rates and CA-CDI proportions (%) were calculated for each province. Both HA- and CA-CDI incidence rates were examined for trends. Types of disparities were summarized and detailed discrepancies were documented. RESULTS: Canadian data were analyzed from nine provinces. The HA-CDI rates ranged from 2.1/10,000 to 6.5/10,000 inpatient-days, with a decreasing trend over time. Available data on CA-CDI showed that both rates and proportions have been increasing over time. Discrepancies among provincial surveillance definitions were documented in CDI case classifications, surveillance populations and rate calculations. CONCLUSION: In Canada overall, the rate of HA-CDI has been decreasing and the rate of CA-CDI has been increasing, although this calculation was impeded by discrepancies in CDI-related definitions among provincial surveillance programs. Nationally-adopted common definitions for CDI would enable better comparisons of CDI rates between provinces and a calculation of the pan-Canadian burden of illness to support vaccine decision-making.
BACKGROUND: Two vaccines against Clostridioides difficile infections (CDI) are currently in phase III trials. To enable decision-making on their use in public health programs, national disease epidemiology is necessary. OBJECTIVES: To determine the epidemiology of hospital-acquired CDI (HA-CDI) and community-associated CDI (CA-CDI) in Canada using provincial surveillance data and document discrepancies in CDI-related definitions among provincial surveillance programs. METHODS: Publicly-available CDI provincial surveillance data from 2011 to 2016 that distinguished between HA-CDI and CA-CDI were included and the most common surveillance definitions for each province were used. The HA-, CA-CDI incidence rates and CA-CDI proportions (%) were calculated for each province. Both HA- and CA-CDI incidence rates were examined for trends. Types of disparities were summarized and detailed discrepancies were documented. RESULTS: Canadian data were analyzed from nine provinces. The HA-CDI rates ranged from 2.1/10,000 to 6.5/10,000 inpatient-days, with a decreasing trend over time. Available data on CA-CDI showed that both rates and proportions have been increasing over time. Discrepancies among provincial surveillance definitions were documented in CDI case classifications, surveillance populations and rate calculations. CONCLUSION: In Canada overall, the rate of HA-CDI has been decreasing and the rate of CA-CDI has been increasing, although this calculation was impeded by discrepancies in CDI-related definitions among provincial surveillance programs. Nationally-adopted common definitions for CDI would enable better comparisons of CDI rates between provinces and a calculation of the pan-Canadian burden of illness to support vaccine decision-making.
Entities:
Keywords:
C. difficile; burden of illness; definitions; epidemiology; surveillance; vaccine
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