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C. difficile infection emerging without risk factors in outpatient population

Hirshon JM. Emerg Infect Dis. 2011;doi:10.3201/eid1710.110069.

Issue: October 2011

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Clostridium difficile infections are increasing in the community among outpatients with no identified risk factors, according to recent findings published in Emerging Infectious Diseases.

In the prospective study, Jon Mark Hirshon, MD, MPH, of the department of emergency medicine at the University of Maryland School of Medicine, and colleagues examined factors associated with C. difficile infection in patients with community-onset diarrheal illnesses who visited EDs and ambulatory primary care clinics affiliated with the university between May 2002 and July 2007 and with Yale–New Haven Hospital between May 2002 and September 2004.

Participants were interviewed to assess health status, symptoms and potential exposures to enteric pathogens. C. difficile toxin tests were performed on 1,091 stool samples collected.

Forty-three (3.9%) stool samples tested positive for C. difficile toxin. The mean age of the patients was 43.7 years.

Although most case-patients (83.7%) had a recognized underlying risk factor for acquiring CDI, the researchers reported that 16.3% of patients had no identified risk factors. Specifically, three cases had no risk factors and no coinfection with another enteric pathogen.

“While we detected toxigenic C. difficile in a similar proportion of patients as was found in other recent studies of community acquired CDI, we found that a lower proportion of patients were without recognized risk factors of recent hospitalization, chronic medical conditions or recent antibiotic exposures than other recent reports,” Hirshon told Infectious Disease News. “An evolving picture of widespread, frequent CDI among outpatients without risk factors should be tempered by these findings.” – by Ashley DeNyse

Disclosure: This study was funded by the National Center for Infectious Diseases of the CDC (grant no. U01CI000296) and the American Association of Medical Colleges (grant no. MM0205-02/02).

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