title: Community-associated Clostridium difficile infection: experience of a veteran affairs medical center in southeastern USA.
abstract: BACKGROUND
  There is increasing recognition of the importance of community-associated Clostridium difficile infection (CA-CDI) despite little being known about its epidemiology.
  
  
  METHODS
  We performed routine, active laboratory surveillance for CDI at the Durham Veterans Affairs Medical Center between January and December 2005 and extracted data from the electronic medical record for this investigation. Bivariable analyses were performed using the chi-square test, and continuous variables were compared using two sample t test and Wilcoxon rank sums.
  
  
  RESULTS
  We identified 108 CDI cases during the study period; 38 (35%) had onset of disease in the community and, of these, 31 (82%) met the definition for CA-CDI. A comparison of CA- versus healthcare facility-associated (HCFA)-CDI revealed that CA-CDI patients were younger (median age 58 vs. 69 years, respectively; p = 0.01), with the majority being <65 years, but had similar co-morbidities to HCFA-CDI patients. CA-CDI patients were reportedly exposed less frequently to an antimicrobial or a proton pump inhibitor than HCFA-CDI patients, while the latter showed a trend towards a higher 60-day all-cause mortality (3 vs. 17%, respectively; p = 0.06).
  
  
  CONCLUSIONS
  CA-CDI is the primary reason for community-onset CDI in our community. Compared to patients with HCFA-CDI, those with CA-CDI were younger, had fewer reported exposures to antimicrobials or PPIs, and had lower mortality. Further study is needed to identify unrecognized risk factors of CDI in the community.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Duke University Medical Center, P.O. Box 102359, 27710 Durham, NC, USA. naggi001@mc.duke.edu
authors.forename: S
authors.initials: S
authors.lastname: Naggie
authors.forename: J
authors.initials: J
authors.lastname: Frederick
authors.forename: B C
authors.initials: BC
authors.lastname: Pien
authors.forename: B A
authors.initials: BA
authors.lastname: Miller
authors.forename: D T
authors.initials: DT
authors.lastname: Provenzale
authors.forename: K C
authors.initials: KC
authors.lastname: Goldberg
authors.forename: C W
authors.initials: CW
authors.lastname: Woods
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015144:Southeastern United States / Q000453:epidemiology; D018709:Statistics, Nonparametric
references.citation: N Engl J Med. 2005 Dec 8;353(23):2442-9
references.pmid: 16322602
references.citation: JAMA. 2005 Dec 21;294(23):2989-95
references.pmid: 16414946
references.citation: Emerg Infect Dis. 2010 Feb;16(2):197-204
references.pmid: 20113547
references.citation: Infect Control Hosp Epidemiol. 2007 Aug;28(8):926-31
references.pmid: 17620239
references.citation: MMWR Morb Mortal Wkly Rep. 2008 Apr 4;57(13):340-3
references.pmid: 18385641
references.citation: N Engl J Med. 2005 Dec 8;353(23):2433-41
references.pmid: 16322603
references.citation: Infect Control Hosp Epidemiol. 2008 Mar;29(3):197-202
references.pmid: 18241032
references.citation: J Infect Dis. 1994 Jan;169(1):127-33
references.pmid: 8277174
references.citation: Clin Infect Dis. 1995 Jun;20 Suppl 2:S263-5
references.pmid: 7548570
references.citation: MMWR Morb Mortal Wkly Rep. 2005 Dec 2;54(47):1201-5
references.pmid: 16319813
references.citation: J Hosp Infect. 2007 Jan;65(1):42-6
references.pmid: 17145108
references.citation: Arch Intern Med. 2006 Dec 11-25;166(22):2518-24
references.pmid: 17159019
references.citation: Infect Control Hosp Epidemiol. 2009 Apr;30(4):332-7
references.pmid: 19239377