Abstract
BackgroundRecent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI.MethodsWe performed a 6-month prospective study of CDI patients to determine frequency of and risk factors for skin and environmental shedding during outpatient visits and to derive a prediction rule for positive cultures. We performed a point–prevalence culture survey to assess the frequency of C. difficile contamination in outpatient settings and evaluated the frequency of prior outpatient visits in patients with community-associated CDI.ResultsOf 67 CDI patients studied, 54 (81%) had 1 or more outpatient visits within 12 weeks after diagnosis. Of 44 patients cultured during outpatient visits, 14 (32%) had skin contamination and 12 (27%) contaminated environmental surfaces. Decreased mobility, fecal incontinence, and treatment with non-CDI antibiotics were associated with positive cultures, whereas vancomycin taper therapy was protective. In patients not on CDI therapy, a prediction rule including incontinence or decreased mobility was 90% sensitive and 79% specific for detection of spore shedding. Of 84 clinic and emergency department rooms cultured, 12 (14%) had 1 or more contaminated environmental sites. For 33 community-associated CDI cases, 31 (94%) had an outpatient visit during the 12 weeks prior to onset of diarrhea.ConclusionsPatients with recent CDI present a significant risk for transmission of spores during outpatient visits. The outpatient setting may be an underappreciated source of community-associated CDI cases.
Highlights
Clostridium difficile is the most important cause of healthcareassociated diarrhea in developed countries [1]
Most cases of C. difficile infection (CDI) are acquired in hospitals or long-term care facilities [2,3], recent reports suggest that community-associated Clostridium difficile infection (CDI) may be increasing in frequency [4,5,6]
We prospectively examined the frequency of and risk factors for skin contamination and environmental shedding of spores by CDI patients at the time of outpatient clinic visits
Summary
Clostridium difficile is the most important cause of healthcareassociated diarrhea in developed countries [1]. Most cases of C. difficile infection (CDI) are acquired in hospitals or long-term care facilities [2,3], recent reports suggest that community-associated CDI (i.e., cases with no healthcare facility admission within 90 days) may be increasing in frequency [4,5,6]. It is plausible that a significant proportion of community-associated CDI cases may in actuality be healthcare-associated, but with acquisition occurring in outpatient rather than inpatient facilities. Many patients with recently diagnosed CDI are seen in outpatient clinics after discharge from healthcare facilities. Recent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
