Case Selection and Definition

Population-based CDI surveillance was conducted in Monroe County, New York (population 747 727), and in Benton, Morrison, Olmsted, Stearns, and Todd Counties in Minnesota (population 400 397) (Table 1). An incident CDI case was defined as a positive C. difficile test on a specimen from a catchment-area resident ≥1 year of age with no positive test result in the previous 8 weeks [16]. Medical records were reviewed, and the information collected was used to classify cases into 4 epidemiological classifications: (1) hospital-onset (HO) (positive specimen collected ≥4 days after hospital admission); (2) long-term care facility onset (LTCO) (positive specimen collected in a LTCF or ≤3 days after a LTCF resident was transferred to a hospital); (3) community-onset–healthcare facility–associated (CO-HCFA) (positive specimen collected in the community or ≤3 days after hospital admission in a person with an overnight stay in a healthcare facility in the prior 12 weeks); and (4) CA (positive specimen collected in the community or ≤3 days after hospital admission in a person with no overnight stay in a healthcare facility in the prior 12 weeks). The HCA category includes HO, LTCO, and CO-HCFA. The project underwent ethical review and approval by the University of Rochester and Rochester Regional Health System and was exempted by the Minnesota Department of Health Intuitional Review Board.

Characteristics of Clostridioides difficile Infection Surveillance Sites

Abbreviations: CDI, Clostridioides difficile infection; LTCFs, long-term care facilities.