title: Community-acquired Clostridium difficile infections.
abstract: OBJECTIVE
  To describe the management and treatment of community-acquired C. difficile infections (CDI) and to evaluate family physicians' (FP) knowledge and practice.
  
  
  METHODS
  Observational study from December 2013 to June 2014. All community-acquired CDI case patients diagnosed in the community or at the University Hospital of Nantes were prospectively included. A questionnaire was mailed to 150 FPs of the area of Nantes.
  
  
  RESULTS
  A total of 27 community-acquired CDI case patients were included (incidence: 7.7 case patients/100,000 inhabitants). Mean age was higher among case patients diagnosed at hospital (69years) compared with those diagnosed in the community (44years). Fifteen patients were treated at home (55%) and 22 received a first-line treatment with metronidazole. Only one patient did not receive any prior antibiotic treatment. Amoxicillin-clavulanic acid was mainly prescribed (68%) for respiratory and ENT infections (40%). Twenty-three patients were cured on Day 7 and three had complications (two deaths). Thirty-one of 47 FPs reported to have already managed CDI patients. Twenty-two FPs reported to usually treat patients with uncomplicated CDI at home, 21 to refer patients to a specialist, and three to hospital. Forty-one FPs reported to prescribe a CD toxin test only after recent antibiotic exposure and 30 when patients are at risk of CDI.
  
  
  CONCLUSIONS
  The incidence and impact of community-acquired CDIs may be underestimated and the unjustified use of antibiotics may promote their emergence. FPs are not used to treat CDIs as more than 50% prefer referring patients to hospital or to a specialist.
authors.affiliation: Pôle de gérontologie clinique, CHU de Nantes, 44093 Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Penit
authors.affiliation: Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Bemer
authors.affiliation: Laboratoire d'analyses médicales Biolance, 44000 Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Besson
authors.affiliation: Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France.
authors.forename: L
authors.initials: L
authors.lastname: Cazet
authors.affiliation: Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Bourigault
authors.affiliation: Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France.
authors.forename: M-E
authors.initials: ME
authors.lastname: Juvin
authors.affiliation: Pôle de gérontologie clinique, CHU de Nantes, 44093 Nantes, France.
authors.forename: M-H
authors.initials: MH
authors.lastname: Fix
authors.affiliation: Service d'hépato-gastro-entérologie, CHU de Nantes, 44093 Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Bruley des Varannes
authors.affiliation: Service des maladies infectieuses et tropicales, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France.
authors.forename: D
authors.initials: D
authors.lastname: Boutoille
authors.affiliation: Service d'accueil des urgences, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Batard
authors.affiliation: Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France. Electronic address: didier.lepelletier@chu-nantes.fr.
authors.forename: D
authors.initials: D
authors.lastname: Lepelletier
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005194:Family Practice; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile; Community-acquired infections; Infections communautaires