Epidemiology of community-onset Clostridium difficile infection in a community in the south of England

ABSTRACT

Clostridium difficile infection [CDI] has traditionally been considered a hospital acquired infection but there are a rising number of infections in the community. This study estimates the prevalence of community-onset CDI [CO-CDI], defined as onset of symptoms in a community setting and outside the hospital, and examines the risk factors for CO-CDI in 2-64 year-olds. A standard questionnaire was used to retrospectively obtain information on the CDI risk factors of 58 cases of CO-CDI diagnosed between 1st April 2008 and 31st March 2009 in a community in the South of England. Each case was reviewed for the presence of 'established' risk factors for CDI, i.e., age >/= 65 years, in-patient hospital stay, and recent [within antibiotics, and other, 'non-established' risk factors for CDI, such as exposure to antibiotics more than 4 weeks preceding symptom onset, out-patient and day-surgery hospital exposure, contact with a hospitalized patient, and travel outside of the UK. Fifty-eight cases of CO-CDI were diagnosed among a total community population of 418,000, representing an estimated prevalence of CO-CDI of 1.29 per 10,000. All 58 cases were successfully contacted, representing a 100% response rate. Four cases were excluded from further analysis due to co-infection with Salmonella spp. and Campylobacter spp. Cases were more likely to be female, aged between 31 and 40 years, and present in the spring season [March-May], 2009. 46.3% [25/54] of cases had established risk factors for CDI, 20.4% [11/54] had non-established risk factors, 16.7% [9/54] had no risk factors and in the remaining 16.7% [9/54], available information was insufficient to classify by risk factor category. This study suggests that CDI should be included in the differential diagnosis of community-onset diarrhea in patients with or without established risk factors for CDI