The incidence and clinical symptomatology of Clostridium difficile infections in a community setting in a cohort of Danish patients attending general practice

Abstract

Clostridium difficile infection (CDI) is gradually being recognised as a cause of morbidity in the community. We investigated the incidence and clinical characteristics of CDI in a community setting and characterised the C. difficile strains by toxin gene profiling and polymerase chain reaction (PCR) ribotyping. Patients included in the study had attended general practice, primarily because of diarrhoea; CDI patients (259 patients; 121 <2 years of age) had positive cultures for toxigenic C. difficile and non-CDI patients (455 patients) were culture-negative. Outcome variables included the frequency and duration of diarrhoea, vomiting, stomach ache, fever >38 °C, weight loss and sick leave. Data were analysed by logistic regression. CDI patients <2 and ≥2 years of age with C. difficile as the only enteropathogen in the faecal sample reported slimy stools (65% vs. 62%), stomach ache (60% vs. 75%), weight loss (50% vs. 76%) and duration of diarrhoea >15 days (59% vs. 73%) as the predominant symptoms. CDI patients ≥2 years old reported duration of diarrhoea >15 days more often compared to non-CDI patients (73% vs. 27 %, p < 0.0001). The annual incidence of CDI was 518 and 23/100,000 for patients <2 and ≥2 years of age, respectively, and 46/100,000 in the subgroup of patients ≥60 years of age. CDI was characterised by stomach ache and persistent diarrhoea, often leading to weight loss. This emphasises the importance of diagnosing CDI not only in hospitalised patients, but also in individuals ≥2 years of age attending general practice because of gastrointestinal symptoms, especially in the elderly, where the incidence of CDI is high.

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

“…Although Dial et al 27 also used data from the UK General Practice Research Database, the authors reported that there was no overlap between this and Dial et al 25 because they used different case definitions for CDI 27 . Additionally, 2 publications (Soes et al 28 and Soes et al 29 ) reported results from the same Danish cohort. Therefore, Delaney et al 26 and Soes et al 29 were excluded from the analyses.…”

“…Additionally, 2 publications (Soes et al 28 and Soes et al 29 ) reported results from the same Danish cohort. Therefore, Delaney et al 26 and Soes et al 29 were excluded from the analyses.…”

“…Two publications reported results divided into groups. Kutty et al 30 presented the results of 2 populations (Veterans Affairs and Durham County residents), whereas Soes et al 28 , 29 presented the results divided into 2 age groups (<2 years and ≥2 years). Among the included studies, 7 were case-control studies and 5 were nested case-control studies.…”

“…The age of the participants ranged from 3 months to 101 years. Only one study 28 , 29 used exclusively positive C. difficile culture in the case definition and another study 31 used a combination of C. difficile culture or toxin test results in the case definition. All studies evaluated exposure to medication for at least 6 weeks and presence of comorbidities for at least 12 weeks prior to the index date, respectively (Table 2).…”

Community- and Healthcare-AssociatedClostridium difficileInfections, Finland, 2008−20131

“…data). Data for the Netherlands and Denmark suggest that current estimations of CA-CDI incidence are largely underestimated because of low diagnostic activity ( 25 – 27 ).…”