title: Emergence of community-acquired Clostridium difficile infection: the experience of a French hospital and review of the literature.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI).
  
  
  METHODS
  The cases of 136 adult patients with CDI treated at the University Hospital of Tours, France between 2008 and 2012 are described. This was a retrospective study.
  
  
  RESULTS
  Among the 136 patients included, 62 were men and 74 were women. Their median age was 64.4 years (range 18-97 years). Twenty-six of the 136 (19%) cases were community-acquired (CA) and 110 (81%) were healthcare-acquired (HCA). The major risk factors for both groups were long-term treatment with proton pump inhibitors (54% of CA, 53% of HCA patients) and antibiotic treatment within the 2.5 months preceding the CDI (50% of CA, 91% of HCA). The CSI was higher in the CA-CDI group (1.56) than in the HCA-CDI group (1.39). Intensive care was required for 8% of CA-CDI and 16.5% of HCA-CDI patients.
  
  
  CONCLUSIONS
  CDI can cause community-acquired diarrhoea, and CA-CDI may be more severe than HCA-CDI. Prospective studies of CDI involving people from the general community without risk factors are required to confirm this observation.
authors.affiliation: Infectious Diseases Department, University Hospital of Tours, 2 boulevard Tonnellé, 37000 Tours, France. Electronic address: m.ogielska@chu-tours.fr.
authors.forename: Maja
authors.initials: M
authors.lastname: Ogielska
authors.affiliation: UMR1282, INRA - University of Tours, Tours, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lanotte
authors.affiliation: UMR1282, INRA - University of Tours, Tours, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Le Brun
authors.affiliation: Bacteriology and Virology Department of Bretonneau, University Hospital of Tours, France(c)Bacteriology Department of Trousseau, University Hospital of Tours, Tours, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Valentin
authors.affiliation: Medical Intensive Care Unit, University Hospital of Tours, Tours, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Garot
authors.affiliation: Surgical Intensive Care Unit, University Hospital of Tours, Tours, France.
authors.forename: Anne-Charlotte
authors.initials: AC
authors.lastname: Tellier
authors.affiliation: Kidney Transplant Department, University Hospital of Tours, Tours, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Halimi
authors.affiliation: Haematology Department, University Hospital of Tours, Tours, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Colombat
authors.affiliation: Pneumology Department, University Hospital of Tours, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Guilleminault
authors.affiliation: Internal Medicine Department, University Hospital of Tours, Tours, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lioger
authors.affiliation: Oncology Department, University Hospital of Tours, Tours, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Vegas
authors.affiliation: Neurology Department, University Hospital of Tours, Tours, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: De Toffol
authors.affiliation: Geriatric Medicine Department, University Hospital of Tours, Tours, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Constans
authors.affiliation: Infectious Diseases Department, University Hospital of Tours, 2 boulevard Tonnellé, 37000 Tours, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000276:immunology / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000196:embryology* / Q000401:mortality; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D003967:Diarrhea / Q000453:epidemiology / Q000821:virology; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Clostridium Severity Index score; Clostridium difficile; Community infection; Proton pump inhibitors