title: Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting.
abstract: OBJECTIVE
  The incidence of Clostridium difficile infection has increased and has been observed among persons from the community who have not been exposed to antibiotics or health care settings. Our aims are to determine prevalence of C difficile infection among emergency department (ED) patients with diarrhea and the prevalence among patients without traditional risk factors.
  
  
  METHODS
  We conducted a prospective observational study of patients aged 2 years or older with diarrhea (≥3 episodes/24 hours) and no vomiting in 10 US EDs (2010 to 2013). We confirmed C difficile infection by positive stool culture result and toxin assay. C difficile infection risk factors were antibiotic use or overnight health care stay in the previous 3 months or previous C difficile infection. We typed strains with pulsed-field gel electrophoresis.
  
  
  RESULTS
  Of 422 participants, median age was 46 years (range 2 to 94 years), with median illness duration of 3.0 days and 43.4% having greater than or equal to 10 episodes of diarrhea during the previous 24 hours. At least one risk factor for C difficile infection was present in 40.8% of participants; 25.9% were receiving antibiotics, 26.9% had health care stay within the previous 3 months, and 3.3% had previous C difficile infection. Forty-three participants (10.2%) had C difficile infection; among these, 24 (55.8%) received antibiotics and 19 (44.2%) had health care exposure; 17 of 43 (39.5%) lacked any risk factor. Among participants without risk factors, C difficile infection prevalence was 6.9%. The most commonly identified North American pulsed-field gel electrophoresis (NAP) strains were NAP type 1 (23.3%) and NAP type 4 (16.3%).
  
  
  CONCLUSIONS
  Among mostly adults presenting to US EDs with diarrhea and no vomiting, C difficile infection accounted for approximately 10%. More than one third of patients with C difficile infection lacked traditional risk factors for the disease. Among participants without traditional risk factors, prevalence of C difficile infection was approximately 7%.
authors.affiliation: Department of Emergency Medicine, Olive View-University of California, Los Angeles Medical Center, Sylmar, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA. Electronic address: fmasjc@ucla.edu.
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Abrahamian
authors.affiliation: Department of Emergency Medicine, Olive View-University of California, Los Angeles Medical Center, Sylmar, CA; Division of Infectious Diseases, Department of Internal Medicine, Olive View-University of California, Los Angeles Medical Center, Sylmar, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
authors.forename: David A
authors.initials: DA
authors.lastname: Talan
authors.affiliation: Department of Emergency Medicine, Olive View-University of California, Los Angeles Medical Center, Sylmar, CA.
authors.forename: Anusha
authors.initials: A
authors.lastname: Krishnadasan
authors.affiliation: R. M. Alden Research Laboratory, Culver City, CA.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Citron
authors.affiliation: Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Paulick
authors.affiliation: Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GA.
authors.forename: Lydia J
authors.initials: LJ
authors.lastname: Anderson
authors.affiliation: David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; R. M. Alden Research Laboratory, Culver City, CA.
authors.forename: Ellie J C
authors.initials: EJC
authors.lastname: Goldstein
authors.affiliation: Department of Emergency Medicine, Olive View-University of California, Los Angeles Medical Center, Sylmar, CA; Division of Infectious Diseases, Department of Internal Medicine, Olive View-University of California, Los Angeles Medical Center, Sylmar, CA; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D004636:Emergency Service, Hospital; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000635:transmission; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult