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. 2013 Jul 22;173(14):1359-67.
doi: 10.1001/jamainternmed.2013.7056.

Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011

Amit S Chitnis  1 , Stacy M Holzbauer, Ruth M Belflower, Lisa G Winston, Wendy M Bamberg, Carol Lyons, Monica M Farley, Ghinwa K Dumyati, Lucy E Wilson, Zintars G Beldavs, John R Dunn, L Hannah Gould, Duncan R MacCannell, Dale N Gerding, L Clifford McDonald, Fernanda C Lessa
Affiliations

Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011

Amit S Chitnis et al. JAMA Intern Med. .

Abstract

Importance: Clostridium difficile infection (CDI) has been increasingly reported among healthy individuals in the community. Recent data suggest that community-associated CDI represents one-third of all C difficile cases. The epidemiology and potential sources of C difficile in the community are not fully understood.

Objectives: To determine epidemiological and clinical characteristics of community-associated CDI and to explore potential sources of C difficile acquisition in the community.

Design and setting: Active population-based and laboratory-based CDI surveillance in 8 US states.

Participants: Medical records were reviewed and interviews performed to assess outpatient, household, and food exposures among patients with community-associated CDI (ie, toxin or molecular assay positive for C difficile and no overnight stay in a health care facility within 12 weeks). Molecular characterization of C difficile isolates was performed. Outpatient health care exposure in the prior 12 weeks among patients with community-associated CDI was a priori categorized into the following 3 levels: no exposure, low-level exposure (ie, outpatient visit with physician or dentist), or high-level exposure (ie, surgery, dialysis, emergency or urgent care visit, inpatient care with no overnight stay, or health care personnel with direct patient care).

Main outcomes and measures: Prevalence of outpatient health care exposure among patients with community-associated CDI and identification of potential sources of C difficile by level of outpatient health care exposure.

Results: Of 984 patients with community-associated CDI, 353 (35.9%) did not receive antibiotics, 177 (18.0%) had no outpatient health care exposure, and 400 (40.7%) had low-level outpatient health care exposure. Thirty-one percent of patients without antibiotic exposure received proton pump inhibitors. Patients having CDI with no or low-level outpatient health care exposure were more likely to be exposed to infants younger than 1 year (P = .04) and to household members with active CDI (P = .05) compared with those having high-level outpatient health care exposure. No association between food exposure or animal exposure and level of outpatient health care exposure was observed. North American pulsed-field gel electrophoresis (NAP) 1 was the most common (21.7%) strain isolated; NAP7 and NAP8 were uncommon (6.7%).

Conclusions and relevance: Most patients with community-associated CDI had recent outpatient health care exposure, and up to 36% would not be prevented by reduction of antibiotic use only. Our data support evaluation of additional strategies, including further examination of C difficile transmission in outpatient and household settings and reduction of proton pump inhibitor use.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.
Ascertainment and classification of patients with community-associated Clostridium difficile infection, 2009 through 2011.
See this image and copyright information in PMC

Comment in

References

    1. Barbut F, Corthier G, Charpak Y, et al. Prevalence and pathogenicity of Clostridium difficile in hospitalized patients: a French multicenter study. Arch Intern Med. 1996;156(13):1449–1454. - PubMed
    1. Bartlett JG. Historical perspectives on studies of Clostridium difficile and C. difficile infection. Clin Infect Dis. 2008;46(suppl 1):S4–S11. - PubMed
    1. Centers for Disease Control and Prevention (CDC). Severe Clostridium difficile–associated disease in populations previously at low risk: four states, 2005. MMWR Morb Mortal Wkly Rep. 2005;54(47):1201–1205. - PubMed
    1. Centers for Disease Control and Prevention (CDC). Surveillance for community-associated Clostridium difficile: Connecticut, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(13):340–343. - PubMed
    1. Kutty PK, Woods CW, Sena AC, et al. Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA. Emerg Infect Dis. 2010;16(2):197–204. - PMC - PubMed

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