{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:34:54Z","timestamp":1786628094775,"version":"build-2736575974"},"reference-count":15,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Clostridioides difficile (C. difficile) is ubiquitous and remains a public health concern with substantial morbidity and economic burden. Active-duty service members (ADSMs) are a distinctive population given their younger age, frequent travel, antibiotic exposure, and close living conditions. This study updates the epidemiology of C. difficile infection (CDI) in ADSMs from 2016 to 2024.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n This retrospective analysis utilized data from 2.7 million ADSMs between January 2016 and December 2024 from the Medical Assessment and Readiness System. CDI was identified using ICD-10 codes. We extracted associated sociodemographic, occupational, and clinical variables, including age, sex, race\/ethnicity, BMI, selected comorbidities, CDI treatment, and gastrointestinal diagnoses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 2,489 CDI cases were identified, with an overall incidence rate of 21.4 per 100,000 person-years. Total annual infections declined from 324 in 2016 to 183 in 2024. Cases were concentrated in the Army (41.5%) and Air Force (28.0%). Women had a higher risk than men (risk ratio [RR], 1.7; 95% CI, 1.6-1.9). Risk increased with age, with ADSMs aged &gt;50 at the highest risk (RR, 6.0; 95% CI, 4.6-7.9). Vancomycin was the most frequently recorded therapy, with lower use of metronidazole and fidaxomicin.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In a large military cohort, CDI incidence was modest yet clinically relevant, with higher risk among women and heterogeneity across service branches. Compared with prior research, the overall incidence of CDI among ADSMs has increased, but over this observation window, the annual CDI incidence has declined by 43.5%. Gastrointestinal diagnoses, including irritable bowel syndrome and inflammatory bowel disease, were more frequently recorded among service members with CDI, including during follow-up after the index diagnosis. Findings support targeted prevention and follow-up, including outpatient antimicrobial stewardship and structured post-CDI care pathways.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/milmed\/usag386","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:39:00Z","timestamp":1785843540000},"source":"Crossref","is-referenced-by-count":0,"title":["Characterization of\n Clostridioides difficile<\/i>\n in the U.S. Military, 2016-2024"],"prefix":"10.1093","author":[{"given":"Ashley M","family":"Foulkrod","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Womack Army Medical Center , Fort Bragg, NC 28310,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A","family":"Beltran","sequence":"additional","affiliation":[{"name":"Department of Clinical Investigation, Womack Army Medical Center , Fort Bragg, NC 28310,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M","family":"Ordway","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Womack Army Medical Center , Fort Bragg, NC 28310,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"2026081308470679100_usag386-B1","author":"Centers for Disease Control and Prevention"},{"key":"2026081308470679100_usag386-B2","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1056\/NEJMoa1801550","article-title":"Changes in prevalence of inpatient-associated infections in US hospitals","volume":"379","author":"Magill","year":"2018","journal-title":"N Engl J Med"},{"key":"2026081308470679100_usag386-B3","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1056\/NEJMoa1408913","article-title":"Burden of Clostridium difficile infection in the United 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management of Clostridium difficile infection","volume":"108","author":"Surawicz","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"2026081308470679100_usag386-B7","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s12879-023-08096-0","article-title":"The burden of CDI in the United States: a multifactorial challenge","volume":"23","author":"Feuerstadt","year":"2023","journal-title":"BMC Infect Dis"},{"key":"2026081308470679100_usag386-B8","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1017\/ash.2022.369","article-title":"A systematic review of real-world health care resource use and costs of Clostridioides difficile infections","volume":"3","author":"Malone","year":"2023","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"2026081308470679100_usag386-B9","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1186\/1471-2334-13-609","article-title":"Epidemiology of Clostridium difficile infection among active duty United States military personnel (1998\u20132010)","volume":"13","author":"Guti\u00e9rrez","year":"2013","journal-title":"BMC Infect Dis"},{"key":"2026081308470679100_usag386-B10","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1053\/j.gastro.2015.07.059","article-title":"Increased risk of functional gastrointestinal sequelae after Clostridium difficile infection among active duty United States military personnel (1998\u20132010)","volume":"149","author":"Guti\u00e9rrez","year":"2015","journal-title":"Gastroenterology"},{"key":"2026081308470679100_usag386-B11","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1053\/j.gastro.2017.04.044","article-title":"Higher incidence of Clostridium difficile infection among individuals with inflammatory bowel disease","volume":"153","author":"Singh","year":"2017","journal-title":"Gastroenterology"},{"key":"2026081308470679100_usag386-B12","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG clinical guidelines: prevention, diagnosis, and treatment of Clostridioides difficile infections","volume":"116","author":"Kelly","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"2026081308470679100_usag386-B13","doi-asserted-by":"publisher","first-page":"e84","DOI":"10.1097\/mcg.0000000000001536","article-title":"Postinfection irritable bowel syndrome following clostridioides difficile infection","volume":"56","author":"Saha","year":"2022","journal-title":"J Clin Gastroenterol"},{"key":"2026081308470679100_usag386-B14","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/cix1085","article-title":"Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America","volume":"66","author":"McDonald","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2026081308470679100_usag386-B15","doi-asserted-by":"publisher","first-page":"e1029","DOI":"10.1093\/cid\/ciab549","article-title":"Clinical practice guideline by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America: 2021 focused update guidelines on management of Clostridioides difficile infection in adults","volume":"73","author":"Johnson","year":"2021","journal-title":"Clin Infect Dis"}],"container-title":["Military 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