Traditional risk factors, including antimicrobial use, hospitalization, account for majority of cases
THURSDAY, Sept. 15 (HealthDay News) -- The majority of patients with diarrhea caused by Clostridium difficile (C. difficile) infection (CDI) have recognized risk factors or a co-infection with another pathogen, according to a study published online Sept. 14 in the U.S. Centers for Disease Control and Prevention's Emerging Infectious Diseases.
Jon Mark Hirshon, M.D., M.P.H., from the University of Maryland School of Medicine in Baltimore, and colleagues investigated CDI in 1,091 patients with diarrhea who visited emergency departments and ambulatory primary care clinics from May 2002 to July 2007, and identified the associated microbiologic causes and epidemiologic characteristics, as well as any patient antimicrobial drug use within the past month. Stool samples were analyzed for C. difficile toxin. Age of 65 years or older, serious underlying illness/weakened immune system, history of bowel or ulcer surgery, colon disease, previous CDI, and recent hospitalization were noted as infection risk factors.
The investigators identified C. difficile toxin in 43 stool specimens (3.9 percent). Antimicrobial use within the preceding month, hospitalization, and chronic illness or bowel surgery affecting immune status or gastrointestinal function was observed in 62.8, 32.6, and 34.9 percent of patients, respectively. Non-health care-associated CDI without accompanying risk factors was identified in seven patients (16.3 percent). Three patients had no risk factors or co-infection with another enteric pathogen. Patients with CDI were found to be older than others with diarrhea (43.4 versus 29.2 years).
"An evolving picture of widespread, frequent CDI among outpatients without risk factors should be tempered by these findings," the authors write."