Tags

Type your tag names separated by a space and hit enter

A case-control study of community-associated Clostridium difficile infection.
J Antimicrob Chemother. 2008 Aug; 62(2):388-96.JA

Abstract

OBJECTIVES

The aim of this study was to determine the incidence of and risk factors for community-associated Clostridium difficile infection (CDI).

METHODS

Prospective surveillance of community-derived faecal samples for C. difficile cytotoxin, followed by a questionnaire-based case-control study in two distinct patient cohorts (one semi-rural and the other urban).

RESULTS

The proportion of randomly selected faecal samples positive for C. difficile cytotoxin was 2.1% in both patient cohorts (median ages 73 and 45 years for the urban and semi-rural cohorts, respectively). Exposure to antibiotics in the previous 4 weeks, particularly multiple agents (P < 0.001), aminopenicillins (P < 0.05) and oral cephalosporins (P < 0.05), was significantly more frequent among cases than controls. Hospitalization in the preceding 6 months was significantly associated with CDI (45% versus 23%; P = 0.022). However, almost half the cases had not received antibiotic therapy in the month before C. difficile detection, and approximately one-third neither had exposure to antibiotics nor recent hospitalization. Contact with infants aged < or =2 years was significantly associated with CDI (14% versus 2%; P = 0.02). Prior exposure to gastrointestinal-acting drugs (proton pump inhibitor, H2 antagonist or non-steroidal anti-inflammatory) was not significantly more common in CDI cases. C. difficile PCR ribotype 001 caused 60% and 13% of urban and semi-rural community-associated CDI cases, respectively.

CONCLUSIONS

Reliance on antibiotic history and age (> or =65 years) will contribute to missed diagnoses of community-associated CDI. Potential risk factors for community-associated CDI should be explored further to explain the large proportion of cases not linked to recent antibiotic therapy or hospitalization.

Authors+Show Affiliations

Department of Microbiology, Leeds Teaching Hospitals, Old Medical School, Leeds LS1 3EX, UK. mark.wilcox@leedsth.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18434341

Citation

Wilcox, M H., et al. "A Case-control Study of Community-associated Clostridium Difficile Infection." The Journal of Antimicrobial Chemotherapy, vol. 62, no. 2, 2008, pp. 388-96.
Wilcox MH, Mooney L, Bendall R, et al. A case-control study of community-associated Clostridium difficile infection. J Antimicrob Chemother. 2008;62(2):388-96.
Wilcox, M. H., Mooney, L., Bendall, R., Settle, C. D., & Fawley, W. N. (2008). A case-control study of community-associated Clostridium difficile infection. The Journal of Antimicrobial Chemotherapy, 62(2), 388-96. https://doi.org/10.1093/jac/dkn163
Wilcox MH, et al. A Case-control Study of Community-associated Clostridium Difficile Infection. J Antimicrob Chemother. 2008;62(2):388-96. PubMed PMID: 18434341.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case-control study of community-associated Clostridium difficile infection. AU - Wilcox,M H, AU - Mooney,L, AU - Bendall,R, AU - Settle,C D, AU - Fawley,W N, Y1 - 2008/04/22/ PY - 2008/4/25/pubmed PY - 2008/8/13/medline PY - 2008/4/25/entrez SP - 388 EP - 96 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 62 IS - 2 N2 - OBJECTIVES: The aim of this study was to determine the incidence of and risk factors for community-associated Clostridium difficile infection (CDI). METHODS: Prospective surveillance of community-derived faecal samples for C. difficile cytotoxin, followed by a questionnaire-based case-control study in two distinct patient cohorts (one semi-rural and the other urban). RESULTS: The proportion of randomly selected faecal samples positive for C. difficile cytotoxin was 2.1% in both patient cohorts (median ages 73 and 45 years for the urban and semi-rural cohorts, respectively). Exposure to antibiotics in the previous 4 weeks, particularly multiple agents (P < 0.001), aminopenicillins (P < 0.05) and oral cephalosporins (P < 0.05), was significantly more frequent among cases than controls. Hospitalization in the preceding 6 months was significantly associated with CDI (45% versus 23%; P = 0.022). However, almost half the cases had not received antibiotic therapy in the month before C. difficile detection, and approximately one-third neither had exposure to antibiotics nor recent hospitalization. Contact with infants aged < or =2 years was significantly associated with CDI (14% versus 2%; P = 0.02). Prior exposure to gastrointestinal-acting drugs (proton pump inhibitor, H2 antagonist or non-steroidal anti-inflammatory) was not significantly more common in CDI cases. C. difficile PCR ribotype 001 caused 60% and 13% of urban and semi-rural community-associated CDI cases, respectively. CONCLUSIONS: Reliance on antibiotic history and age (> or =65 years) will contribute to missed diagnoses of community-associated CDI. Potential risk factors for community-associated CDI should be explored further to explain the large proportion of cases not linked to recent antibiotic therapy or hospitalization. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/18434341/A_case_control_study_of_community_associated_Clostridium_difficile_infection_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkn163 DB - PRIME DP - Unbound Medicine ER -