Among patients with community-associated Clostridium difficile infection, more than a third had not used antibiotics in the 12 weeks before diagnosis and more than half reported limited or no health care contact over the same period.
To assess possible sources of infection, Dr. Amit S. Chitnis and his colleagues at the Centers for Disease Control and Prevention reviewed the medical records of, and interviewed, 984 patients with new-onset community-associated C. difficile infection (CDI).
The patients’ median age was 51 years and median Charlson comorbidity index 0. Almost 90% were white; two-thirds were women; 41% had preceding outpatient care such as surgery or dialysis.
Investigators found that 400 patients (41%) reported low-level health care exposure, such as a visit to a physician or dentist, while 177 (18%) reported no exposure (JAMA Intern. Med. 2013;173:1359-67).
Sixty-four percent (631) reported antibiotic use within 12 weeks of diagnosis, while 28% (273) reported using a PPI, and 9% (90) reported using an H2-receptor antagonist. Among 177 patients with no health care contact, 44% had used antibiotics, 24% used a PPI, and 12% had used H2-receptor antagonists.
Patients with no, or limited, health care contact were significantly more likely to live with an active CDI case or have contact with infants under a year old, who can be asymptomatic CDI carriers. There were no associations between CDI and animal exposure. "Prevention of community-associated CDI should primarily focus on reducing inappropriate antibiotic use and better infection control practices in outpatient settings," the investigators concluded. They suggested evaluating CDI transmission in household settings and reduction of PPI use.
The CDC funded the work. The authors reported no conflicts of interest.