A prospective study of community-associated Clostridium difficile infection in Kuwait: Epidemiology and ribotypes

• To study incidence of community-acquired Clostridium difficile infection (CA-CDI) in Kuwait.
• Of the 2584 patients with diarrhea, 16 (0.62%) were confirmed cases of CA-CDI.
• Exposure to antibiotics was significantly associated with CA-CDI.
• Contact with infant aged <2 years was significantly associated with CA-CDI.
• The most common C. difficile ribotype belonged to the European PCR-Ribotype 139.

Clostridium difficile infection (CDI) is increasingly recognized as a significant community acquired pathogen that causes disease in the community. The aim of the study was to investigate prospectively the incidence of community-acquired-CDI (CA-CDI) in Kuwait. Of the 2584 patients with diarrhea, 16 (0.62%) were confirmed cases of CA-CDI. The other notable pathogens were Salmonella spp. (0.39%) and Campylobacter spp. (0.23%). The mean age was 39 years and the CDI was mild. Exposure to antibiotics in the previous 12 weeks, contact with infant aged <2 years and history of foreign travel was significantly associated with CA-CDI (P < 0.001; P < 0.0001; P < 0.002, respectively). Detected PCR ribotypes were 139 (n = 4) and 014, 056, 070, 097 and 179 (each n = 2). CA-CDI in Kuwait is more likely to occur in younger age and associated with ribotype 139. CA-CDI is not a common problem in Kuwait however extra vigilance must be maintained to detect it in the community even without traditional predisposing factors.