Community and Healthcare-Associated Clostridioides difficile Infection in the UK: Risk Factors from a South East England Integrated Care Board

Aim : This study aimed to explore and identify risk factors for community and hospital-onset CDI within a South East England Integrated Care Board (ICB) during the 2022/2023 financial year, enhancing understanding to inform prevention strategies. Methods : A retrospective cross-sectional analysis was conducted using secondary data from four NHS Trusts during the 2022/2023 financial year. CDI cases were confirmed by positive C. difficile toxin results and loose stool (Bristol stool types 5–7). Post-infection review (PIR) outcomes were analysed descriptively to identify contributory factors. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) and Microsoft Excel. Results: Across the ICB, 308 CDI cases were reported: Trust A= 52 (threshold 21), Trust B=129 (threshold 82), Trust C= 77 (threshold 62), Trust D= 50 (threshold 34). PIR analysis revealed multiple contributing factors: inappropriate antibiotic use (4.9%), appropriate antibiotic use (12.6%), proton-pump inhibitors (2.3%), steroids (0.6%), laxatives (0.3%), immunosuppression (1.9%), CDI relapses (2.6%), prolonged hospitalisation (0.6%), and cross-infection (1.3%). Discussion These results highlight a complex interplay of antimicrobial exposure, other medications, and patient-related factors in the acquisition of both community-onset and hospital-onset in CDI. Significance and impact: This is the first UK study using ICB data to assess both community and hospital-onset CDI risk factor. The findings underscore the need for targeted antimicrobial stewardship, careful medication review, and enhanced education for healthcare professionals and patients to reduce CDI incidence and improve outcomes.