A case-control study of community-associated Clostridium difficile infection

Area of Science:

• Infectious Diseases
• Microbiology
• Epidemiology

Background:

• Community-associated Clostridium difficile infection (CDI) is a growing concern.
• Understanding its incidence and risk factors is crucial for effective prevention and treatment.

Purpose of the Study:

• To determine the incidence of community-associated Clostridium difficile infection (CDI).
• To identify risk factors associated with community-associated CDI.

Main Methods:

• Prospective surveillance of community-derived fecal samples for C. difficile cytotoxin.
• A questionnaire-based case-control study in urban and semi-rural patient cohorts.

Main Results:

• The incidence of C. difficile cytotoxin in fecal samples was 2.1% in both cohorts.
• Antibiotic exposure, particularly multiple agents and specific oral antibiotics, was a significant risk factor.
• Hospitalization within the preceding 6 months was associated with CDI.
• A notable proportion of cases lacked recent antibiotic therapy or hospitalization.
• Contact with young children (aged ≤2 years) was a significant risk factor.
• C. difficile PCR ribotype 001 was prevalent in urban cases.

Conclusions:

• Relying solely on antibiotic history and age (≥65 years) can lead to missed CDI diagnoses.
• Further investigation into risk factors is necessary to explain cases not linked to recent antibiotic therapy or hospitalization.