<i>Clostridium difficile</i>Infection in Outpatients, Maryland and Connecticut, USA, 2002–2007

Hirshon, Jon Mark; Thompson, Angela; Limbago, Brandi; McDonald, L. Clifford; Bonkosky, Michelle; Heimer, Robert; Meek, James; Mai, Volker; Braden, Christopher R.

doi:10.3201/eid1710.110069

Cited by 26 publications

(13 citation statements)

References 14 publications

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“…One‐quarter of them had no underlying illness or hospitalization in the preceding year [19]. Similar results were seen in four other studies, where 16%, 26%, 35% and 40% had no antibiotic use or admission preceding their CA‐CDI [22,26,31,32]. Furthermore, severe CDI was reported among previously low‐risk populations, such as healthy individuals and pregnant women [4].…”

Section: Patient and Strain Characteristics In Ca‐cdisupporting

confidence: 76%

“…When the number of people serviced by a laboratory or hospital (catchment area) is unknown, incidences cannot be determined, and only the percentage of positive tests can be reported. Patients presenting to the GP with diarrhoea have a positive test result for CDI in 2–6% of cases [9,17,23–26]. This increases to c. 10% when antibiotics are used or a physician specifically requests testing, often because risk factors are present [23,27].…”

Section: Occurrence Of CDI In the Communitymentioning

confidence: 99%

“…Only 32–88% used antibiotic therapy before their diarrhoea, and the mean age was below 65 years in all but one study (Table 1) [5]. Four studies that reported relatively low antibiotic usage might have suffered from patient recall bias [14,26,28,31]. However, a large study performed by Dial et al.…”

Section: Patient and Strain Characteristics In Ca‐cdimentioning

confidence: 99%

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Clostridium difficile infection in the community: a zoonotic disease?

Hensgens

Keessen

Squire

et al. 2012

Clinical Microbiology and Infection

263

200

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Clin Microbiol Infect 2012; 18: 635–645 Abstract Clostridium difficile infections (CDIs) are traditionally seen in elderly and hospitalized patients who have used antibiotic therapy. In the community, CDIs requiring a visit to a general practitioner are increasingly occurring among young and relatively healthy individuals without known predisposing factors. C. difficile is also found as a commensal or pathogen in the intestinal tracts of most mammals, and various birds and reptiles. In the environment, including soil and water, C. difficile may be ubiquitous; however, this is based on limited evidence. Food products such as (processed) meat, fish and vegetables can also contain C. difficile, but studies conducted in Europe report lower prevalence rates than in North America. Absolute counts of toxigenic C. difficile in the environment and food are low, however the exact infectious dose is unknown. To date, direct transmission of C. difficile from animals, food or the environment to humans has not been proven, although similar PCR ribotypes are found. We therefore believe that the overall epidemiology of human CDI is not driven by amplification in animals or other sources. As no outbreaks of CDI have been reported among humans in the community, host factors that increase vulnerability to CDI might be of more importance than increased exposure to C. difficile. Conversely, emerging C. difficile ribotype 078 is found in high numbers in piglets, calves, and their immediate environment. Although there is no direct evidence proving transmission to humans, circumstantial evidence points towards a zoonotic potential of this type. In future emerging PCR ribotypes, zoonotic potential needs to be considered.

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Section: Patient and Strain Characteristics In Ca‐cdisupporting

confidence: 76%

Section: Occurrence Of CDI In the Communitymentioning

confidence: 99%

See 1 more Smart Citation

Clostridium difficile infection in the community: a zoonotic disease?

Hensgens

Keessen

Squire

et al. 2012

Clinical Microbiology and Infection

263

200

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“…A subsequent study of the prevalence of CDI among community-dwellers testing positive for CDI in the evaluation of acute diarrheal syndromes showed that 43 of 1091 (3.9 %) such patients tested positive for C. difficile , but only 3 patients (0.3%) remained as possible CDI patients when more recognized causes of outpatient gastroenteritis such as norovirus were excluded. 98 CDI remains extremely unlikely as a cause of outpatient gastroenteritis based on available evidence.…”

Section: Epidemiology Of CDImentioning

confidence: 99%

Clostridium difficile

Curry¹

2010

Clinics in Laboratory Medicine

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SYNOPSIS Clostridium difficile infections (CDI) have emerged as one of the principal threats to the health of hospitalized and immunocompromised patients. Nucleic acid testing for C. difficile toxin genes has eclipsed traditional clinical diagnostics for CDI in sensitivity and is now widespread in clinical use, but preliminary evidence suggests that this may have come at a cost of substantially reduced positive predictive value. The importance of C. difficile colonization is increasingly recognized not only as a source for false positive clinical testing but also as a source of new infections within hospitals and other healthcare environments. In the last five years, several new treatment strategies that capitalize on the increasing understanding of the altered microbiome and host defenses in CDI patients have completed clinical trials, including fecal microbiota transplantation (FMT). This article highlights the changing epidemiology, laboratory diagnostics, pathogenesis, and treatment of CDI.

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“…Landmark events contributed to boost the interest on CDI from the medical community over the last 10 years, including: i) hospital outbreaks of unusually severe and recurrent CDI, beginning in the second half of 2002 and extending through 2006 in Québec, Canada(3); ii) dissemination of the strain responsible for this outbreak, now commonly designated 'NAP1/BI/027', in the USA and in Europe (4, 5); iii) emerging reports suggesting that CDI is also significantly encountered in patients who would be erroneously considered without risk, such as community-acquired CDI in patients with no recent antibiotic use (6)(7)(8), or CDI during pregnancy(9); iv) the development and the diversification of diagnostic tests, in-house or commercial, much faster than the pace of recommendations available to guide their use in routine practice (10,11).…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile infections: do we know the real dimensions of the problem?

Tattevin

Buffet-Bataillon

Donnio

et al. 2013

International Journal of Antimicrobial Agents

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Clostridium difficile infection (CDI) is the primary cause of nosocomial diarrhoea in industrialised countries, usually occurring as a complication of antibiotic therapy in elderly patients. Landmark events contributed to boosting interest in CDI over the last 10 years, including the emergence of unusually severe and recurrent CDI due to the NAP1/BI/027 strain, as well as reports suggesting that CDI is also significantly encountered in patients previously considered at no risk, such as community-acquired CDI in patients with no recent antibiotic use, or CDI during pregnancy. Despite this growing interest from the medical community, we do not know the real dimensions of the disease for the following reasons: (i) despite comprehensive guidelines published in Europe and in the USA, most laboratories still use diagnostic tests with suboptimal sensitivity as a 'rule-out' test, hence a significant proportion of CDIs remain undiagnosed; (ii) use of PCR as a stand-alone test by others will probably overestimate the real incidence of CDI and jeopardise any comparison between institutions with different diagnostic procedures; and (iii) transversal studies, with optimum design and diagnostic tests, are rapidly outdated due to the dramatic changes in CDI epidemiology that may occur from one year to another. To get an accurate picture of the real dimensions of the CDI issue, we need more systematic use of an adequate and homogeneous diagnostic strategy in the field as well as the implementation of continuous monitoring of CDI incidence through surveillance programmes.

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Clostridium difficileInfection in Outpatients, Maryland and Connecticut, USA, 2002–2007

Cited by 26 publications

References 14 publications

Clostridium difficile infection in the community: a zoonotic disease?

Clostridium difficile infection in the community: a zoonotic disease?

Clostridium difficile

Clostridium difficile infections: do we know the real dimensions of the problem?

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