Could you estimate the global burden of Clostridium difficile infection (CDI) and describe the prevalence trends of this infection in the recent decades?
Christine Lee: With regard to the global burden of CDI, it is not quite known because it is not always reportable. But we do know that in North America over half a million individuals are affected by the infection each year. Combining that with the European countries, it is likely 1 million individuals each year.
With regard to the health-care–associated infections of CDI, it used to be approximately 85 per 100,000 patient-days in 1995, but over the next 2 decades it has actually declined in terms of health-care–associated CDI to approximately 50 per 100,000 patient-days.
What we are seeing is more of community-associated CDI. Some may argue that although we would label it as community-associated, there may be a link to health care. But we are seeing individuals who have not been to any health-care facilities and who have not even received antibiotics coming in with CDI.