C. difficile Infections on the Rise in Outpatient Settings

Cases of clostridium difficile are on the rise in outpatient settings, according to new research from the Mayo Clinic.

The researchers found that 158 of the cases of C. difficile that they encountered were community-acquired. Cases of C. difficile were seen in 35 patients from nursing homes, and the median age for patients with community-acquired C. difficile was 50. Patients with community infections had a severe illness 22% of the time, and patients with this kind of illness were less likely than patients with hospital-acquired C. difficile to have been exposed to antibiotics prior to contracting the infection.

In contrast, patients with hospital-acquired C. difficile accounted for 192 of the patients the researchers saw. Patients with a hospital-acquired infection had a median age of 72, and 35% of these patients experienced a severe illness. Because the individuals with hospital-acquired C. difficile were more likely to have been exposed to antibiotics prior to contracting the infection, they had two of the primary risk factors for infection: recent hospitalization and exposure to antibiotics.

"Doctors have gotten better at spotting C. difficile in hospitals and nursing homes,” said Darrell Pardi, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota and senior author on the study. “However, now doctors and patients need to be more aware that you can get this infection as an outpatient and that a case of diarrhea or abdominal cramps at home could become serious.”

Altogether, the researchers performed a population-based study of 385 patients who presented with C. difficile between 1991-2005. Results that showed little difference between hospital-acquired and community-acquired cases were the treatments patients received (primarily metronidazole), response rates, and recurrence rates after treatment.

"We are seeing more cases of C. difficile in the community, but they tend to be less severe and in a younger population," Pardi said. "The growing incidence of C. difficile infection in both inpatient and outpatient settings could be linked to the increasing usage of antibiotics and to the possibility that C. difficile may be getting resistant to some of our newer antibiotics."

Results of this study were presented at the 2009 American College of Gastroenterology (ACG) Annual Meeting, held October 23-28 in San Diego.