title: Community-acquired Clostridium difficile infections in emergency departments.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) has become an emerging infectious disease, especially in community settings. Little data is available on its frequency and characteristics in France. We aimed to describe CDI case patients consulting at the emergency department and to compare community-acquired and nosocomial CDIs.
  
  
  METHODS
  We conducted a multicenter retrospective study over a three-year period of community-acquired and nosocomial CDI case patients seen at the emergency department and compared their characteristics.
  
  
  RESULTS
  A total of 2055 patients consulted for diarrhea during the study period and had a stool culture performed: 66 (3.2%) presented with a CDI, of which 28 were community-acquired and 26 were nosocomial. Community-acquired CDI patients had a mean age of 57.7years (18-91), with a sex-ratio of 0.65. At least one risk factor was observed in 24 patients (85.7%), of whom 22 (78.6%) had been prescribed a previous antimicrobial treatment. Diabetes mellitus and renal failure were more frequently observed in patients presenting with nosocomial CDI. They required fluid replacement and needed be to re-hospitalized more often than community-acquired patients.
  
  
  CONCLUSIONS
  Community-acquired CDIs in the emergency department account for approximately 1.4% of patients presenting with diarrhea. One risk factor is present in 85.7% of cases. In our study, their presentation and outcome seemed less severe than nosocomial CDIs.
authors.affiliation: Service des maladies infectieuses, hôpital Raymond-Poincaré, HU PIFO, APHP, université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard R. Poincaré, 92380 Garches, France.
authors.forename: D
authors.initials: D
authors.lastname: Lefevre-Tantet-Etchebarne
authors.affiliation: Laboratoire de microbiologie, université Versailles-Saint-Quentin-en-Yvelines, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France.
authors.forename: V
authors.initials: V
authors.lastname: Sivadon-Tardy
authors.affiliation: Service des maladies infectieuses, hôpital Raymond-Poincaré, HU PIFO, APHP, université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard R. Poincaré, 92380 Garches, France; Infectiologie transversale, université Versailles-Saint-Quentin-en-Yvelines, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France.
authors.forename: B
authors.initials: B
authors.lastname: Davido
authors.affiliation: Pharmacie, hôpital Raymond-Poincaré, HU PIFO, APHP,université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard R. Poincaré, 92380 Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Service d'accueil des urgences, université Versailles-Saint-Quentin-en-Yvelines, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France.
authors.forename: J
authors.initials: J
authors.lastname: Grenet
authors.affiliation: Service de microbiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
authors.forename: E
authors.initials: E
authors.lastname: Farfour
authors.affiliation: Service d'accueil des urgences et service mobile d'urgence et de réanimation, hôpital de Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard 78300 Poissy, France.
authors.forename: R
authors.initials: R
authors.lastname: Getti
authors.affiliation: Service des maladies infectieuses, hôpital Raymond-Poincaré, HU PIFO, APHP, université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard R. Poincaré, 92380 Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Duran
authors.affiliation: Service de biologie, hôpital de Poissy-Saint-Germain-en-Laye, 10, rue du Champ-Gaillard 78300 Poissy, France.
authors.forename: M
authors.initials: M
authors.lastname: Chéron
authors.affiliation: Service d'accueil d'urgence, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
authors.forename: E
authors.initials: E
authors.lastname: Mathieu
authors.affiliation: Service des maladies infectieuses, hôpital Raymond-Poincaré, HU PIFO, APHP, université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard R. Poincaré, 92380 Garches, France.
authors.forename: J
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Service des maladies infectieuses, hôpital Raymond-Poincaré, HU PIFO, APHP, université Versailles-Saint-Quentin-en-Yvelines, 104, boulevard R. Poincaré, 92380 Garches, France; Infectiologie transversale, université Versailles-Saint-Quentin-en-Yvelines, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France. Electronic address: aurelien.dinh@aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Dinh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D048909:Diabetes Complications / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Clostridium difficile; Community-acquired infection; Infection communautaire; Sepsis grave; Severe sepsis