PMC

Effectiveness of Clostridium difficile infection (CDI) control parameters on incidence of infection quantified as percentage change in hospital-onset CDI (HO-CDI), community-onset CDI (CO-CDI), and long-term care facility (LTCF)–onset CDI (LO-CDI), quantified as percentage change in incidence per 1% change in each of 5 transmission parameters. Error bars indicate 95% CIs. LTCF, long-term care facility.

Increase in Clostridium difficile infection (CDI) incidence from use of antimicrobial drugs for in hospital-onset (HO-CDI), community-onset (CO-CDI), and long-term care facility–onset (LO-CDI) illnesses classified by drug risk ratio for CDI. Clostridium difficile infection (CDI) incidence from use of antimicrobial drugs for low through high CDI risk. Change in CDI incidence is measured as a multiple of the CDI incidence for an antimicrobial drug risk ratio = 1.0. Error bars indicate 95% CIs.

Compartmental model structure for Clostridium difficile infection (CDI) within each setting (hospital, long-term care facility, and community). Patients are classified as not receiving antimicrobial drugs (N), are receiving antimicrobial drugs (A), having a recent history of receiving antimicrobial drugs (O), uncolonized (U), asymptomatically colonized (C), symptomatically infected (CDI), or colonized and subject to recurrence (RC) of CDI. Arrows indicate changes in individual epidemiologic status. Subscripts indicate primary, secondary, or tertiary CDI.

Transitions between settings (hospital, LTCF, and the non–healthcare community) for model structure of Clostridium difficile infection (CDI). Transitions were parameterized at demographically calibrated, age-specific rates. Hospitalized patients with CDI who were given a diagnosis are subject to enhanced isolation protocols that reduce transmission. All hospitalized CDI patients are discharged at a slower rate than non–CDI patients, which reflects longer hospitalization attributable to CDI. N, patients not receiving antimicrobial drugs; A, patients receiving antimicrobial drugs; O, patients with a recent history of receiving antimicrobial drugs; U, uncolonized patients; C, asymptomatically colonized patients; RC, symptomatically infected patients or colonized patients and subject to recurrence; LTCF, long-term care facility. Solid arrows indicate changes in individual epidemiologic status and patient movement between the hospital, community, and LTCF. Dashed arrows indicate isolation of CDI patients.