Inclusion of emergency department attendance on classification of Clostridioides difficile infection-onset status: a revised definition

Algorithms used to classify Clostridioides difficile infection (CDI) as hospital- or community-onset have commonly relied on the duration between patient hospital admission and specimen date for classification. This, however, fails to account for patient stays in emergency departments prior to inpatient hospital admission. The UK Health Security Agency addresses this concern in a revised definition, implemented as of April 2024. In England, from April 2020 to March 2024, conventional definitions led to 6.7% of hospital-onset CDI cases being misclassified as community-onset. These findings reinforce the rationale for updating England's CDI-onset definition, ensuring more accurate and standardized CDI categorization.