Community-onset Clostridium difficile infection at a tertiary medical center in southern Taiwan, 2007-2015

Research paper by Chin-Shiang Tsai, Yuan-Pin Hung; Jen-Chieh Lee; Nan-Yao Lee; Po-Lin Chen; Ling-Shan Syue; Ming-Chi Li; Chia-Wen Li; Wen-Chien Ko

Indexed on: 08 Jan '17Published on: 20 Dec '16Published in: Journal of Microbiology, Immunology and Infection


Publication date: Available online 18 December 2016 Source:Journal of Microbiology, Immunology and Infection Author(s): Chin-Shiang Tsai, Yuan-Pin Hung, Jen-Chieh Lee, Nan-Yao Lee, Po-Lin Chen, Ling-Shan Syue, Ming-Chi Li, Chia-Wen Li, Wen-Chien Ko Background Clostridium difficile infection (CDI) is well-known as the major cause of infectious diarrhea in hospitalized patients. Community-onset CDI (CO-CDI) becomes an emerging threat. However, clinical information of CO-CDI in Taiwan remains scarce. Methods A retrospective study was conducted at a medical center in southern Taiwan. Symptomatic patients between 2007 and 2015 with C. difficile toxin or tcdB detected in stool were identified as CDI, and were classified as CO-CDI (including community-associated CDI [CA-CDI] and community-onset healthcare facility-associated CDI [CO-HCFA-CDI]) and healthcare facility-onset CDI (HCFO-CDI). Results Of 427 cases, 15 (3.5%) were CA-CDI, 49 (11.5%) CO-HCFA-CDI, and 363 (85.0%) HCFO-CDI. Despite major involvement of the elderly (mean age: 66.1 vs. 69.9 years, P = 0.46), no significant differences were noted between CA-CDI and CO-HCFA-CDI groups, except that solid organ cancer was more common in CO-HCFA-CDI group. The CO-CDI group more often presented with abdominal pain but had shorter hospital stays and less exposure of proton-pump inhibitors or broad-spectrum antibiotics than the HCFO-CDI group did. The mortality rate related to CDI was 4.7% (3 cases) in the CO-CDI group. Despite a lower in-hospital mortality rate in the CO-CDI group (10.9% vs. 22.0%; P = 0.04), the recurrence rate was similar (10.9% vs. 7.2%; P = 0.3). Conclusions CO-CDI is not common but associated with substantial morbidity and mortality. Physicians should put CDI into consideration among patients who confront community-onset fever, diarrhea, or abdominal pain alone or in combination.