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. 2012 Jan;107(1):89-95.
doi: 10.1038/ajg.2011.398. Epub 2011 Nov 22.

The epidemiology of community-acquired Clostridium difficile infection: a population-based study

Sahil Khanna  1 , Darrell S Pardi, Scott L Aronson, Patricia P Kammer, Robert Orenstein, Jennifer L St Sauver, W Scott Harmsen, Alan R Zinsmeister
Affiliations

The epidemiology of community-acquired Clostridium difficile infection: a population-based study

Sahil Khanna et al. Am J Gastroenterol. 2012 Jan.

Erratum in

  • Am J Gastroenterol. 2012 Jan;107(1):150

Abstract

Objectives: Clostridium difficile infection (CDI) is a common hospital-acquired infection with increasing incidence, severity, recurrence, and associated morbidity and mortality. There are emerging data on the occurrence of CDI in nonhospitalized patients. However, there is a relative lack of community-based CDI studies, as most of the existing studies are hospital based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired CDI.

Methods: To better understand the epidemiology of community-acquired C. difficile infection, a population-based study was conducted in Olmsted County, Minnesota, using the resources of the Rochester Epidemiology Project. Data regarding severity, treatment response, and outcomes were compared in community-acquired vs. hospital-acquired cohorts, and changes in these parameters, as well as in incidence, were assessed over the study period.

Results: Community-acquired CDI cases accounted for 41% of 385 definite CDI cases. The incidence of both community-acquired and hospital-acquired CDI increased significantly over the study period. Compared with those with hospital-acquired infection, patients with community-acquired infection were younger (median age 50 years compared with 72 years), more likely to be female (76% vs. 60%), had lower comorbidity scores, and were less likely to have severe infection (20% vs. 31%) or have been exposed to antibiotics (78% vs. 94%). There were no differences in the rates of complicated or recurrent infection in patients with community-acquired compared with hospital-acquired infection.

Conclusions: In this population-based cohort, a significant proportion of cases of CDI occurred in the community. These patients were younger and had less severe infection than those with hospital-acquired infection. Thus, reports of CDI in hospitalized patients likely underestimate the burden of disease and overestimate severity.

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Conflict of interest statement

Conflict of Interest

Guarantor of the article: Darrell S. Pardi, MD, MS, FACG.

Figures

Figure 1
Figure 1
Patient classification
Figure 2
Figure 2. Incidence rates of Clostridium difficile infection in Olmsted County, Minnesota
The top two panels show the incidence data for the overall study population, both age-specific (2A), and age and gender adjusted rates over time (2B). The middle two panels show the incidence of community-acquired infection, both age-specific (2C), and age and gender adjusted rates over time (2D). The lower two panels show the incidence of hospital-acquired infection, both age-specific (2E) and by calendar period (2F).
Figure 3
Figure 3. Age-specific incidence rates of Clostridium difficile infection over time in Olmsted County, Minnesota
The curves depict changes in the incidence of CDI in specific age groups over the duration of the study.
See this image and copyright information in PMC

Comment in

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