Increased Community-Associated Clostridioides difficile Infections in Quebec, Canada, 2008–2015

Veronica Zanichelli; Christophe Garenc; Jasmin Villeneuve; Danielle Moisan; Charles Frenette; Vivian Loo; Yves Longtin


Emerging Infectious Diseases. 2020;26(6):1291-1294. 

In This Article

Abstract and Introduction


The annual incidence rate of community-associated Clostridioides difficile infections in Quebec, Canada, has increased by 33.3%, from 0.51 (2008) to 0.68 (2015) cases/100,000 population, while incidence of healthcare-associated cases remained relatively stable. Possible causes include increased disease severity, increased antimicrobial drug use, emergence of virulent strains, and heightened physician awareness.


Clostridioides difficile infections (CDIs) are commonly acquired in healthcare settings.[1] In 2003, an outbreak of CDI in the province of Quebec, Canada (population, 8.2 million), required implementation of mitigation strategies and prompted introduction of a surveillance program.[2,3] Afterward, incidence of healthcare-associated CDIs (HA-CDIs) in the province decreased from 13.7 cases/10,000 patient-days in 2004–2005 to 6.9/10,000 patient-days in 2014–2015. Although CDIs afflict mainly hospitalized patients, recent studies report increased incidence of community-associated CDIs (CA-CDIs).[4–6] Whereas most of the focus in North America has been on HA-CDI, we describe and compare long-term trends in incidence rates for HA-CDI and CA-CDI in Quebec.