title: Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands.
abstract: To elucidate the prevalence, characteristics and risk factors of community-onset Clostridium difficile infection (CO-CDI), an uncontrolled prospective study was performed. For 3 months in 2007-2008, three laboratories in The Netherlands tested all unformed stool samples submitted by general practitioners (GPs) for C. difficile by enzyme immunoassay for toxins A and B, irrespective of whether GPs specifically requested this. Patients with positive results were asked to complete a questionnaire. Positive stool samples were cultured for C. difficile, and isolates were characterized. In all, 2443 stool samples from 2423 patients were tested, and 37 patients (1.5%) with positive toxin test results were identified. Mixed infections were not found. Age varied from 1 to 92 years, and 18% were under the age of 20 years. Diarrhoea was typically frequent and watery, sometimes with admixture of blood or fever. Eight of 28 patients (29%) suffered recurrences. Among 31 patients with toxin-positive stool samples for whom information was available, 20 (65%) had not been admitted to a healthcare institution in the year before, 13 (42%) had not used antibiotics during the 6 months before, and eight (26%) had neither risk factor. A separate analysis for patients whose samples were both toxin-positive and culture-positive produced similar results. Cultured C. difficile isolates belonged to 13 different PCR ribotypes, and 24% of the isolates were non-typeable (rare or new) PCR ribotypes. In conclusion, CO-CDI can affect all age groups, and many patients do not have known risk factors. Several PCR ribotypes not encountered in hospital-associated outbreaks were found, suggesting the absence of a direct link between outbreaks and community-onset cases.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands. m.p.bauer@lumc.nl
authors.forename: M P
authors.initials: MP
authors.lastname: Bauer
authors.forename: D
authors.initials: D
authors.lastname: Veenendaal
authors.forename: L
authors.initials: L
authors.lastname: Verhoef
authors.forename: P
authors.initials: P
authors.lastname: Bloembergen
authors.forename: J T
authors.initials: JT
authors.lastname: van Dissel
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D021521:Ribotyping; D012307:Risk Factors; D055815:Young Adult