Community-acquired Clostridium difficile infections in emergency departments

Clostridium difficile infection (CDI) has become an emerging infectious disease, especially in community settings. Little data is available on its frequency and characteristics in France. We aimed to describe CDI case patients consulting at the emergency department and to compare community-acquired and nosocomial CDIs.

We conducted a multicenter retrospective study over a three-year period of community-acquired and nosocomial CDI case patients seen at the emergency department and compared their characteristics.

A total of 2055 patients consulted for diarrhea during the study period and had a stool culture performed: 66 (3.2%) presented with a CDI, of which 28 were community-acquired and 26 were nosocomial. Community-acquired CDI patients had a mean age of 57.7years (18-91), with a sex-ratio of 0.65. At least one risk factor was observed in 24 patients (85.7%), of whom 22 (78.6%) had been prescribed a previous antimicrobial treatment. Diabetes mellitus and renal failure were more frequently observed in patients presenting with nosocomial CDI. They required fluid replacement and needed be to re-hospitalized more often than community-acquired patients.

Community-acquired CDIs in the emergency department account for approximately 1.4% of patients presenting with diarrhea. One risk factor is present in 85.7% of cases. In our study, their presentation and outcome seemed less severe than nosocomial CDIs.