The epidemiology of community-acquired clostridium difficile infection: A population-based study

Sahil Khanna, Darrell S. Pardi, Scott L. Aronson, Patricia P. Kammer, Robert Orenstein, Jennifer L. St Sauver, W. Scott Harmsen, Alan R. Zinsmeister

Research output: Contribution to journalArticle

367 Scopus citations

Abstract

Objectives: Clostridium difficile infection (CDI) is a common hospital-acquired infection with increasing incidence, severity, recurrence, and associated morbidity and mortality. There are emerging data on the occurrence of CDI in nonhospitalized patients. However, there is a relative lack of community-based CDI studies, as most of the existing studies are hospital based, potentially influencing the results by referral or hospitalization bias by missing cases of community-acquired CDI. Methods: To better understand the epidemiology of community-acquired C. difficile infection, a population-based study was conducted in Olmsted County, Minnesota, using the resources of the Rochester Epidemiology Project. Data regarding severity, treatment response, and outcomes were compared in community-acquired vs. hospital-acquired cohorts, and changes in these parameters, as well as in incidence, were assessed over the study period. Results: Community-acquired CDI cases accounted for 41% of 385 definite CDI cases. The incidence of both community-acquired and hospital-acquired CDI increased significantly over the study period. Compared with those with hospital-acquired infection, patients with community-acquired infection were younger (median age 50 years compared with 72 years), more likely to be female (76% vs. 60%), had lower comorbidity scores, and were less likely to have severe infection (20% vs. 31%) or have been exposed to antibiotics (78% vs. 94%). There were no differences in the rates of complicated or recurrent infection in patients with community-acquired compared with hospital-acquired infection. Conclusions: In this population-based cohort, a significant proportion of cases of CDI occurred in the community. These patients were younger and had less severe infection than those with hospital-acquired infection. Thus, reports of CDI in hospitalized patients likely underestimate the burden of disease and overestimate severity.

Original languageEnglish (US)
Pages (from-to)89-95
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume107
Issue number1
DOIs
StatePublished - Jan 2012

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Khanna, S., Pardi, D. S., Aronson, S. L., Kammer, P. P., Orenstein, R., St Sauver, J. L., Harmsen, W. S., & Zinsmeister, A. R. (2012). The epidemiology of community-acquired clostridium difficile infection: A population-based study. American Journal of Gastroenterology, 107(1), 89-95. https://doi.org/10.1038/ajg.2011.398