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Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands.
Clin Microbiol Infect. 2009 Dec; 15(12):1087-92.CM

Abstract

To elucidate the prevalence, characteristics and risk factors of community-onset Clostridium difficile infection (CO-CDI), an uncontrolled prospective study was performed. For 3 months in 2007-2008, three laboratories in The Netherlands tested all unformed stool samples submitted by general practitioners (GPs) for C. difficile by enzyme immunoassay for toxins A and B, irrespective of whether GPs specifically requested this. Patients with positive results were asked to complete a questionnaire. Positive stool samples were cultured for C. difficile, and isolates were characterized. In all, 2443 stool samples from 2423 patients were tested, and 37 patients (1.5%) with positive toxin test results were identified. Mixed infections were not found. Age varied from 1 to 92 years, and 18% were under the age of 20 years. Diarrhoea was typically frequent and watery, sometimes with admixture of blood or fever. Eight of 28 patients (29%) suffered recurrences. Among 31 patients with toxin-positive stool samples for whom information was available, 20 (65%) had not been admitted to a healthcare institution in the year before, 13 (42%) had not used antibiotics during the 6 months before, and eight (26%) had neither risk factor. A separate analysis for patients whose samples were both toxin-positive and culture-positive produced similar results. Cultured C. difficile isolates belonged to 13 different PCR ribotypes, and 24% of the isolates were non-typeable (rare or new) PCR ribotypes. In conclusion, CO-CDI can affect all age groups, and many patients do not have known risk factors. Several PCR ribotypes not encountered in hospital-associated outbreaks were found, suggesting the absence of a direct link between outbreaks and community-onset cases.

Authors+Show Affiliations

Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands. m.p.bauer@lumc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19624512

Citation

Bauer, M P., et al. "Clinical and Microbiological Characteristics of Community-onset Clostridium Difficile Infection in the Netherlands." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 15, no. 12, 2009, pp. 1087-92.
Bauer MP, Veenendaal D, Verhoef L, et al. Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands. Clin Microbiol Infect. 2009;15(12):1087-92.
Bauer, M. P., Veenendaal, D., Verhoef, L., Bloembergen, P., van Dissel, J. T., & Kuijper, E. J. (2009). Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 15(12), 1087-92. https://doi.org/10.1111/j.1469-0691.2009.02853.x
Bauer MP, et al. Clinical and Microbiological Characteristics of Community-onset Clostridium Difficile Infection in the Netherlands. Clin Microbiol Infect. 2009;15(12):1087-92. PubMed PMID: 19624512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands. AU - Bauer,M P, AU - Veenendaal,D, AU - Verhoef,L, AU - Bloembergen,P, AU - van Dissel,J T, AU - Kuijper,E J, Y1 - 2009/07/16/ PY - 2009/7/24/entrez PY - 2009/7/25/pubmed PY - 2010/1/28/medline SP - 1087 EP - 92 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin Microbiol Infect VL - 15 IS - 12 N2 - To elucidate the prevalence, characteristics and risk factors of community-onset Clostridium difficile infection (CO-CDI), an uncontrolled prospective study was performed. For 3 months in 2007-2008, three laboratories in The Netherlands tested all unformed stool samples submitted by general practitioners (GPs) for C. difficile by enzyme immunoassay for toxins A and B, irrespective of whether GPs specifically requested this. Patients with positive results were asked to complete a questionnaire. Positive stool samples were cultured for C. difficile, and isolates were characterized. In all, 2443 stool samples from 2423 patients were tested, and 37 patients (1.5%) with positive toxin test results were identified. Mixed infections were not found. Age varied from 1 to 92 years, and 18% were under the age of 20 years. Diarrhoea was typically frequent and watery, sometimes with admixture of blood or fever. Eight of 28 patients (29%) suffered recurrences. Among 31 patients with toxin-positive stool samples for whom information was available, 20 (65%) had not been admitted to a healthcare institution in the year before, 13 (42%) had not used antibiotics during the 6 months before, and eight (26%) had neither risk factor. A separate analysis for patients whose samples were both toxin-positive and culture-positive produced similar results. Cultured C. difficile isolates belonged to 13 different PCR ribotypes, and 24% of the isolates were non-typeable (rare or new) PCR ribotypes. In conclusion, CO-CDI can affect all age groups, and many patients do not have known risk factors. Several PCR ribotypes not encountered in hospital-associated outbreaks were found, suggesting the absence of a direct link between outbreaks and community-onset cases. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/19624512/Clinical_and_microbiological_characteristics_of_community_onset_Clostridium_difficile_infection_in_The_Netherlands_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(14)64850-3 DB - PRIME DP - Unbound Medicine ER -