Epidemiological and genomic characterization of community-acquired Clostridium difficile infections

Abstract

BackgroundClostridium difficile infection (CDI) is a major cause of morbidity and mortality in North America and Europe. The aim of this study was to identify epidemiologically-confirmed cases of community-acquired (CA)-CDI in a large North American urban center and analyze isolates using multiple genetic and phenotypic methods.MethodsSeventy-eight patients testing positive for C. difficile from outpatient clinics were further investigated by telephone questionnaire. CA-CDI isolates were characterized by antibiotic susceptibility, pulsed-field gel electrophoresis and whole genome sequencing. CA-CDI was defined as testing positive greater than 12 weeks following discharge or no previous hospital admission in conjunction with positive toxin stool testing.Results51.3% (40/78) of the patients in this study were found to have bona fide CA-CDI. The majority of patients were female (71.8% vs. 28.2%) with 50–59 years of age being most common (21.8%). Common co-morbidities included ulcerative colitis (1/40; 2.5%), Crohn’s disease (3/40; 7.5%), celiac disease (2/40; 5.0%) and irritable bowel syndrome (8/40; 20.0%). However, of 40 patients with CA-CDI, 9 (29.0%) had been hospitalized between 3 and 6 months prior and 31 (77.5%) between 6 and 12 months prior. The hypervirulent North American Pulostype (NAP) 1-like (9/40; 22.5%) strain was the most commonly identified pulsotype. Whole genome sequencing of CA-CDI isolates confirmed that NAP 1-like pulsotypes are commonplace in CA-CDI. From a therapeutic perspective, there was universal susceptibility to metronidazole and vancomycin.ConclusionsAll CA-CDI cases had some history of hospitalization if the definition were modified to health care facility exposure in the last 12 months and is supported by the genomic analysis. This raises the possibility that even CA-CDI may have nosocomial origins.

Clostridioides difficile ribotypes 001 and 126 were predominant in Tehran healthcare settings from 2004 to 2018: a 14-year-long cross-sectional study

“…These patients must not have been discharged from a health-care facility in the previous 12 weeks. HA-CDI cases were defined as a patient with the onset of CDI symptoms that occurred more than 48 h after admission or less than 4 weeks after discharge from a health care facility or hospital [23]. The following clinical details were recorded for all subjects: patient demographics; antibiotic and medication history; laboratory data; and underlying health conditions.…”

Gut microbiota features associated with Clostridioides difficile colonization in puppies

“…Administration of antibiotics is the primary risk factor for the development of C . difficile infection (CDI) [1, 6, 7]. However, patients can develop CDI outside of a healthcare facility without the prior use of antibiotics, and community-acquired CDIs are now thought to account for one quarter of infections [8, 9].…”

Incidence and economic burden of Clostridioides difficile infection in Ontario: a retrospective population-based study

“…Careful monitoring for C. difficile infection may include diagnostic testing of older patients with diarrhea who have recently been exposed to antibiotics and asking patients about recent hospital admissions and health care exposure. A 2018 Canadian analysis of isolates in community-acquired cases of C. difficile infection showed that all patients had been admitted in the previous year, 36 which indicates that many, and perhaps all, community-associated cases actually have nosocomial origins.…”