title: The epidemiology of Clostridium difficile infection inside and outside health care institutions.
abstract: This article describes the global changes in Clostridium difficile epidemiology since the late twentieth century and into the twenty-first century when the new epidemic strain BI/NAP1/027 emerged. The article provides an overview of how understanding of C difficile epidemiology has rapidly evolved since its initial association with colitis in 1974. It also discusses how C difficile has spread across the globe, the role of asymptomatic carriers in disease transmission, the increased recognition of C difficile outside health care settings, the changes in epidemiology of C difficile infection in children, and the risk factors for disease.
authors.affiliation: Department of Medicine, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Avenue, Maywood, IL 60153, USA; Research Service, Edward Hines, Jr. Veterans Affairs Hospital, 5000 South Fifth Avenue, Building 1, Room 347, Hines, IL 60141, USA. Electronic address: dale.gerding2@va.gov.
authors.forename: Dale N
authors.initials: DN
authors.lastname: Gerding
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
mesh_terms: D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000382:microbiology*; D006268:Health Facilities; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D014774:Virulence
keywords: Clostridium difficile infection; Community associated; Health care associated; Risk factors; Strain type