November 29, 2017
2 min read

C. difficile on the rise in the community

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Kelly Reveles, PharmD, PhD
Kelly R. Reveles

Researchers observed a shift from health care facility-onset Clostridium difficile infections to community-acquired disease over a 12-year period. Although nosocomial C. difficile infection, or CDI, is the most common type, cases in the community are on the rise, they said.

“CDC estimates that 52% of CDI cases originate in the outpatient setting, predominately in patients with recent contact with a health care system,” Kelly R. Reveles, PharmD, PhD, assistant professor in the College of Pharmacy at The University of Texas, and colleagues wrote. “The majority of CDI epidemiologic data are acquired from hospital administrative data; therefore, few studies have described characteristics of patients with community-onset CDI. Even fewer studies have evaluated health outcomes in these distinct patient populations.”

In a retrospective cohort study, researchers examined data from adults with CDI who received care at any inpatient or outpatient Veterans Health Administration facility in the United States between October 2002 and September 2014. They sorted CDI into three groups: community-associated CDI (CA-CDI); community onset, health care facility-associated CDI (CO-HCFA-CDI); and health care facility-onset CDI (HCFO-CDI). They then examined trends in cases over the 12-year period.

Reveles and colleagues included 30,326 patients with a first CDI episode in the study. Over 60% of patients had HCFO-CDI, whereas 20.6% had CO-HCFA-CDI and 19.2% had CA-CDI. While the number of patients with HCFO-CDI declined from 73.5% in 2003 to 53.2% in 2014, cases of CA-CDI rose from 8.3% to 26.7%. HCFO-CDI was associated with an increased risk for severe CDI (OR = 1.71; 95% CI, 1.59-1.84) and 30-day mortality (OR = 1.46; 95% CI, 1.32-1.61). However, HCFO-CDI was not a predictor of 60-day recurrence (OR = 0.41; 95% CI, 0.37-0.46).

“HCFO-CDI remains the predominant CDI type, but community-onset cases are on the rise. Furthermore, we found that HCFO-CDI patients often have higher rates of severe CDI and mortality and longer hospital stays, but fewer CDI recurrences compared with CA-CDI and CO-HCFA-CDI,” Reveles and colleagues wrote. “Patients with CA-CDI who are older or who have higher comorbidity burden, should be monitored closely and managed more aggressively in the community to prevent poor outcomes.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.