The emergence of community-acquired Clostridium difficile in an Australian hospital

IntroductionThe epidemiology of Clostridium difficile-related illness is changing. This study aimed to compare risk factors between community- and hospital-acquired Clostridium difficile (C. difficile) cases.MethodsThis study was a case-series analysis in a metropolitan tertiary care hospital. A total of 136 hospitalised patients aged 18 years or older who had laboratory-confirmed C. difficile- positive stool samples between 1 September 2011 and 30 September 2012 were analysed. Data were collected electronically from hospital administrative databases. Medical records of patients with toxigenic C. difficile were retrospectively reviewed for clinical information. Data matching was used to provide event-based data of the number of cases infected with C. difficile and their hospital outcomes.ResultsAmonthly average of 9% (15 of 168) of diarrhoeal stool samples were toxigenic test-positive. One-third (n = 37) of C. difficile cases had acquired infection before their hospital admission. These patients were significantly more likely to be diagnosed with enterocolitis due to C. difficile compared with patients who were infected in hospital (24% versus 7%, P = 0.02). Community-acquired C. difficile patients had significantly shorter mean lengths of stay in hospital (14 days versus 48 days for hospital-acquired infection) and were more likely to be discharged before 21 days (81% v. 38%, P < 0.001).ConclusionsPatients with community-acquired C. difficile infection (CDI) contributed to a third of the burden of this infection in the hospital. A quarter of these patients presented to hospital with potentially life-threatening enterocolitis related to the infection. These data suggest that infection with C. difficile demands greater attention, in particular in the community setting.