C. difficile infection not always associated with antibiotic use

Community-acquired Clostridium difficile (C. difficile) infection occurred in a significant proportion of people with no recent exposure to antibiotics, with 53% having no exposure in the 45 days preceding hospitalization and 46% having no exposure in the preceding 90 days, according to a new study published in CMAJ http://www.cmaj.ca/press/pg767.pdf. While C.difficile is mainly known as a hospital-acquired infection, the study participants, aged 65 and over, had not been hospitalized for at least 90 days before being admitted for C. difficile. Dr. Sandra Dial and the team of McGill University-based authors conclude "testing for C. difficile should be considered in community patients with diarrhea in whom a history of antibiotic exposure cannot be elicited."

In a related commentary http://www.cmaj.ca/press/pg747.pdf, Dr. Ed Kuijper and Prof. Jaap van Disselof Leiden University in the Netherlands write that while the lack of antibiotic exposure in people admitted to hospital with C. difficile is interesting, it needs to be determined whether C.difficile is occurring in younger people without risk factors. Several studies suggest this may be the case. The authors state "there is an urgent need to identify and better characterize potential risk factors for community-acquired C.difficile infection to explain the large proportion of cases not linked to recent antibiotic therapy or hospital stays."

Source: Canadian Medical Association Journal