Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Linda Niccolai

Abstract

Background: Clostridioides difficile infection (CDI) is a gastrointestinal infection causing colon inflammation, diarrhea, and potential life-threatening complications. In 2021, treatment guidelines for CDI were updated by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). This study analyzed Connecticut Emerging Infections Program (EIP) data to assess CDI incidence trends (2011-2024) and evaluate physician concordance with 2021 guidelines for incident cases (2022-2024). Methods: The Connecticut EIP conducted CDI surveillance in New Haven County (2011-2023) and South Central and Naugatuck planning regions (2024). Incidence rates were calculated using census data. Concordance was defined as treatment with either fidaxomicin or vancomycin as well as fidaxomicin alone for ≥10 days. Incidence trends were evaluated utilizing a negative binomial distribution for incidence and a Cochran-Mantel-Haenszel test for binary response variables. Concordance was evaluated using a Cochran-Armitage trend test and a Pearson chi-square test of independence for differences in community-associated (CA) and healthcare-associated (HA) CDI cases. Results: From 2011 to 2024, the overall CDI incidence rate decreased by 35.6% and the HA-CDI incidence rate decreased by 53.7%. Treatment with fidaxomicin or vancomycin for ≥10 days among incident CDI cases was 83.8% in 2022, 84.1% in 2023, and 80.9% in 2024. Fidaxomicin use for ≥10 days among incident CDI cases increased from 5.5% in 2022 to 7.5% in 2023 to 9.3% in 2024. A significantly higher proportion of CA-CDI cases received fidaxomicin compared to HA cases in each of the 3 years (p<0.05). Conclusions: From 2011 to 2024, the reduction in total incidence and incidence among HA-CDI cases is notable and may reflect continued infection control and prevention efforts in Connecticut hospitals and healthcare facilities. While low, the proportion of incident cases who received fidaxomicin did improve over the three-year period. More research needs to be done to understand the institutional and patient-level factors associated with low fidaxomicin uptake.

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This is an Open Access Thesis.

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