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Sahil Khanna, Darrell S. Pardi, “Community-Acquired Clostridium difficile Infection: An Emerging Entity”, Clinical Infectious Diseases, Volume 55, Issue 12, 15 December 2012, Pages 1741–1742, https://doi.org/10.1093/cid/cis722
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To the Editor—We read with great interest the article by Lessa et al on the epidemiology of Clostridium difficile infection (CDI) [1]. The authors acknowledge an increasing incidence and severity of CDI all over the world including an emergence of community-acquired CDI with approximately 20%–27% of all CDI cases being community-acquired and an incidence of 20–30 per 100 000 persons [2, 3]. In addition, the authors associate antibiotic or proton pump inhibitor use as risk factors for community-acquired CDI.
Our group performed a population-based study in the Olmsted County, MN, which revealed that 41% of all CDI cases were community-acquired [4]. The overall age- and sex-adjusted incidence for community-acquired CDI was 9.6 per 100 000 persons with a significant increase in incidence with increasing age and more recent calendar period. In our study, as compared to hospital-acquired CDI, patients with community-acquired CDI were significantly younger, had lower comorbidity scores, lower rates of antibiotic exposure, and were less likely to develop severe infection, but had similar recurrence rates [4]. Of the community-acquired CDI patients, 22% were not exposed to prior antibiotics and 78% were not exposed to gastric acid suppression medications, suggesting other potential novel risk factors for acquisition of community-acquired CDI.
