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Int J Infect Dis. 2015 Aug;37:36-41. doi: 10.1016/j.ijid.2015.06.007. Epub 2015 Jun 17.

Emergence of community-acquired Clostridium difficile infection: the experience of a French hospital and review of the literature.

Author information

1
Infectious Diseases Department, University Hospital of Tours, 2 boulevard Tonnellé, 37000 Tours, France. Electronic address: m.ogielska@chu-tours.fr.
2
UMR1282, INRA - University of Tours, Tours, France.
3
Bacteriology and Virology Department of Bretonneau, University Hospital of Tours, France(c)Bacteriology Department of Trousseau, University Hospital of Tours, Tours, France.
4
Medical Intensive Care Unit, University Hospital of Tours, Tours, France.
5
Surgical Intensive Care Unit, University Hospital of Tours, Tours, France.
6
Kidney Transplant Department, University Hospital of Tours, Tours, France.
7
Haematology Department, University Hospital of Tours, Tours, France.
8
Pneumology Department, University Hospital of Tours, Tours, France.
9
Internal Medicine Department, University Hospital of Tours, Tours, France.
10
Oncology Department, University Hospital of Tours, Tours, France.
11
Neurology Department, University Hospital of Tours, Tours, France.
12
Geriatric Medicine Department, University Hospital of Tours, Tours, France.
13
Infectious Diseases Department, University Hospital of Tours, 2 boulevard Tonnellé, 37000 Tours, France.

Abstract

BACKGROUND:

Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI).

METHODS:

The cases of 136 adult patients with CDI treated at the University Hospital of Tours, France between 2008 and 2012 are described. This was a retrospective study.

RESULTS:

Among the 136 patients included, 62 were men and 74 were women. Their median age was 64.4 years (range 18-97 years). Twenty-six of the 136 (19%) cases were community-acquired (CA) and 110 (81%) were healthcare-acquired (HCA). The major risk factors for both groups were long-term treatment with proton pump inhibitors (54% of CA, 53% of HCA patients) and antibiotic treatment within the 2.5 months preceding the CDI (50% of CA, 91% of HCA). The CSI was higher in the CA-CDI group (1.56) than in the HCA-CDI group (1.39). Intensive care was required for 8% of CA-CDI and 16.5% of HCA-CDI patients.

CONCLUSIONS:

CDI can cause community-acquired diarrhoea, and CA-CDI may be more severe than HCA-CDI. Prospective studies of CDI involving people from the general community without risk factors are required to confirm this observation.

KEYWORDS:

Clostridium Severity Index score; Clostridium difficile; Community infection; Proton pump inhibitors

PMID:
26092300
DOI:
10.1016/j.ijid.2015.06.007
[Indexed for MEDLINE]
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