Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus
Background: Clostridium difficile infection (CDI) is increasingly being found in populations without traditional risk factors. We compared the relative frequency, risk factors, severity, and outcomes of community-onset CDI with hospital-acquired infection. Methods: This was a retrospective, observat...
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| Format: | Article |
| Language: | English |
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Elsevier
2014-12-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971214016245 |
| _version_ | 1818157981900996608 |
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| author | Penny Clohessy Juan Merif Jeffrey John Post |
| author_facet | Penny Clohessy Juan Merif Jeffrey John Post |
| author_sort | Penny Clohessy |
| collection | DOAJ |
| description | Background: Clostridium difficile infection (CDI) is increasingly being found in populations without traditional risk factors. We compared the relative frequency, risk factors, severity, and outcomes of community-onset CDI with hospital-acquired infection.
Methods: This was a retrospective, observational study of CDI at a tertiary hospital campus in Sydney, Australia. Patients aged 15 years and older with a first episode of CDI from January 1 to December 31, 2011 were included. CDI was defined as the presence of diarrhoea with a positive enzyme immunoassay in conjunction with a positive cell cytotoxicity assay, toxin culture, or organism culture. Main outcome measures were onset of infection (hospital or community), risk factors, markers of severity, and outcomes for the two groups.
Results: One hundred and twenty-nine cases of CDI infection were identified, of which 38 (29%) were community-onset. The community-onset infection group were less likely to have a recent history of antibiotic use (66% vs. 98%; p < 0.001) or proton pump inhibitor use (38% vs. 69%; p = 0.03) than the hospital-acquired infection group. Markers of severity and outcomes were similar in the two groups, with an overall mortality of 9%.
Conclusions: Community-onset CDI accounts for a large proportion of C. difficile infections and has a similar potential for severe disease as hospital-acquired infection. Using a history of previous antibiotic use, proton pump inhibitor use, or recent hospitalization to predict cases is unreliable. We recommend that patients with diarrhoea being investigated in emergency departments and community practice are tested for Clostridium difficile infection. |
| first_indexed | 2024-12-11T15:22:50Z |
| format | Article |
| id | doaj.art-f09796d35f0c4d3088c917368340f4b8 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 1878-3511 |
| language | English |
| last_indexed | 2024-12-11T15:22:50Z |
| publishDate | 2014-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-f09796d35f0c4d3088c917368340f4b82022-12-22T01:00:19ZengElsevierInternational Journal of Infectious Diseases1201-97121878-35112014-12-0129C15215510.1016/j.ijid.2014.08.009Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campusPenny Clohessy0Juan Merif1Jeffrey John Post2Infectious Diseases Department, Prince of Wales Hospital, Randwick, New South Wales, AustraliaMicrobiology Department, SEALS, Prince of Wales Hospital, Randwick, New South Wales, AustraliaInfectious Diseases Department, Prince of Wales Hospital, Randwick, New South Wales, AustraliaBackground: Clostridium difficile infection (CDI) is increasingly being found in populations without traditional risk factors. We compared the relative frequency, risk factors, severity, and outcomes of community-onset CDI with hospital-acquired infection. Methods: This was a retrospective, observational study of CDI at a tertiary hospital campus in Sydney, Australia. Patients aged 15 years and older with a first episode of CDI from January 1 to December 31, 2011 were included. CDI was defined as the presence of diarrhoea with a positive enzyme immunoassay in conjunction with a positive cell cytotoxicity assay, toxin culture, or organism culture. Main outcome measures were onset of infection (hospital or community), risk factors, markers of severity, and outcomes for the two groups. Results: One hundred and twenty-nine cases of CDI infection were identified, of which 38 (29%) were community-onset. The community-onset infection group were less likely to have a recent history of antibiotic use (66% vs. 98%; p < 0.001) or proton pump inhibitor use (38% vs. 69%; p = 0.03) than the hospital-acquired infection group. Markers of severity and outcomes were similar in the two groups, with an overall mortality of 9%. Conclusions: Community-onset CDI accounts for a large proportion of C. difficile infections and has a similar potential for severe disease as hospital-acquired infection. Using a history of previous antibiotic use, proton pump inhibitor use, or recent hospitalization to predict cases is unreliable. We recommend that patients with diarrhoea being investigated in emergency departments and community practice are tested for Clostridium difficile infection.http://www.sciencedirect.com/science/article/pii/S1201971214016245Clostridium difficileCommunity onsetSeverityFrequency |
| spellingShingle | Penny Clohessy Juan Merif Jeffrey John Post Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus International Journal of Infectious Diseases Clostridium difficile Community onset Severity Frequency |
| title | Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus |
| title_full | Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus |
| title_fullStr | Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus |
| title_full_unstemmed | Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus |
| title_short | Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus |
| title_sort | severity and frequency of community onset clostridium difficile infection on an australian tertiary referral hospital campus |
| topic | Clostridium difficile Community onset Severity Frequency |
| url | http://www.sciencedirect.com/science/article/pii/S1201971214016245 |
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