Emergence of community-acquired Clostridium difficile infection: the experience of a French hospital and review of the literature

•This work completes the last results of the Clostridium difficile infection.•We describe the community-acquired infection, which is not only a real danger to outpatients, but can also be much more severe than nosocomial infection.•We describe the risk factors for Clostridium difficile infection in outpatients.•We found the Clostridium Severity Index (CSI) score to be higher in community-acquired infection.•We present a literature review on community-acquired Clostridium infection.

SummaryBackgroundClostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI).MethodsThe cases of 136 adult patients with CDI treated at the University Hospital of Tours, France between 2008 and 2012 are described. This was a retrospective study.ResultsAmong the 136 patients included, 62 were men and 74 were women. Their median age was 64.4 years (range 18–97 years). Twenty-six of the 136 (19%) cases were community-acquired (CA) and 110 (81%) were healthcare-acquired (HCA). The major risk factors for both groups were long-term treatment with proton pump inhibitors (54% of CA, 53% of HCA patients) and antibiotic treatment within the 2.5 months preceding the CDI (50% of CA, 91% of HCA). The CSI was higher in the CA-CDI group (1.56) than in the HCA-CDI group (1.39). Intensive care was required for 8% of CA-CDI and 16.5% of HCA-CDI patients.ConclusionsCDI can cause community-acquired diarrhoea, and CA-CDI may be more severe than HCA-CDI. Prospective studies of CDI involving people from the general community without risk factors are required to confirm this observation.