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Table 1. Commonly Used Clostridioides difficile Infection (CDI) Surveillance Definitions Case Type Definition Healthcare facility-onset CDI (HO-CDI) CDI symptom onset ≥4 days after admission to a healthcare facility (HCF), with day of admission being day 1. a Healthcare facility-onset, treated CDI (HT-CDI) (e proposed definition is currently being evaluated.) CDI symptom onset ≥4 days aer admission to an HCF, with day of admission being day 1, and ≥5 days of CDI treatment started within 2 calendar days of the positive C. difficile test; if a patient is discharged or transferred before receiving 5 days of treatment, any treatment will count. a Community-onset, healthcare facility- associated CDI (CO- HCFA-CDI) CDI symptom onset in the community or <4 days from admission (day of admission being day 1), provided that symptom onset was <4 weeks aer the last discharge from an HCF, according to National Healthcare Safety Network (NHSN) definitions. a,b Indeterminate onset CDI CDI case patient who does not fit any of the above criteria for an exposure setting, e.g., CDI symptom onset in the community or <4 days from admission (day of admission being day 1) provided that symptom onset was >4 weeks but <12 weeks aer the last discharge from an HCF. a Community-associated CDI (CA-CDI) CDI symptom onset in the community or <4 days from admission (day of admission being day 1), provided that symptom onset was >12 weeks aer the last discharge from an HCF. a Healthcare-associated CDI (HA-CDI) Includes cases of HO-CDI, CO-HCFA-CDI, and indeterminate per CDC Emerging Infections Program definitions. Community-onset CDI (CO-CDI) Includes both CA-CDI and indeterminate CDI (distinct from CO-HCFA-CDI) per NHSN definitions. Unknown Exposure setting cannot be determined because of lack of available data. Recurrent CDI A CDI episode that occurs 8 weeks (56 days) or less aer the onset of a previous CDI episode, provided that CDI symptoms from the earlier episode resolved. a When utilizing laboratory-based reporting symptoms, date and time of stool specimen collection can be used as a surrogate for symptom onset. If data on time a patient was admitted (in addition to date) and/ or time stool was collected for testing are not available, CDI can be considered healthcare facility onset if stool is positive for toxigenic C. difficile or toxin aer the third calendar day from hospital admission, where the first day is the day of admission (i.e., a patient admitted on Monday with stool first positive for C. difficile toxin on ursday or later is considered to have healthcare facility-onset CDI). b CDC Emerging Infections Program definitions include CO-HCFA-CDI cases as defined above and indeterminate onset cases as defined below (i.e., all CDI occurring <12 weeks aer last discharge) in their specific CO-HCFA-CDI definition.

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