Public Health Directorate, NHS Berkshire West, Reading, United Kingdom.
J Infect Public Health. 2010;3(3):118-23. doi: 10.1016/j.jiph.2010.07.002. Epub 2010 Aug 23.
Clostridium difficile infection (CDI) has traditionally been considered a hospital acquired infection but there are a rising number of infections in the community. This study estimates the prevalence of community-onset CDI (CO-CDI), defined as onset of symptoms in a community setting and outside the hospital, and examines the risk factors for CO-CDI in 2-64 year-olds.
A standard questionnaire was used to retrospectively obtain information on the CDI risk factors of 58 cases of CO-CDI diagnosed between 1st April 2008 and 31st March 2009 in a community in the South of England. Each case was reviewed for the presence of 'established' risk factors for CDI, i.e., age ≥65 years, in-patient hospital stay, and recent (within ≤4 weeks) receipt of broad spectrum antibiotics, and other, 'non-established' risk factors for CDI, such as exposure to antibiotics more than 4 weeks preceding symptom onset, out-patient and day-surgery hospital exposure, contact with a hospitalised patient, and travel outside of the UK.
Fifty-eight cases of CO-CDI were diagnosed among a total community population of 418,000, representing an estimated prevalence of CO-CDI of 1.29 per 10,000. All 58 cases were successfully contacted, representing a 100% response rate. Four cases were excluded from further analysis due to co-infection with Salmonella spp. and Campylobacter spp. Cases were more likely to be female, aged between 31 and 40 years, and present in the spring season (March-May), 2009. 46.3% (25/54) of cases had established risk factors for CDI, 20.4% (11/54) had non-established risk factors, 16.7% (9/54) had no risk factors and in the remaining 16.7% (9/54), available information was insufficient to classify by risk factor category.
This study suggests that CDI should be included in the differential diagnosis of community-onset diarrhea in patients with or without established risk factors for CDI.
艰难梭菌感染（CDI）传统上被认为是医院获得性感染，但现在社区感染的数量正在上升。本研究估计了社区获得性 CDI（CO-CDI）的患病率，定义为在社区环境中且不在医院发生的症状发作，并研究了 2-64 岁人群中 CO-CDI 的危险因素。
使用标准问卷回顾性地获取了 2008 年 4 月 1 日至 2009 年 3 月 31 日期间在英格兰南部社区诊断的 58 例 CO-CDI 病例的 CDI 危险因素信息。对每个病例进行了 CDI 的“既定”危险因素（即年龄≥65 岁、住院、最近（≤4 周）接受广谱抗生素）和其他“非既定”危险因素（如症状发作前 4 周以上接触抗生素、门诊和日间手术医院暴露、接触住院患者和英国境外旅行）的审查。
在总共 418000 名社区人群中诊断出 58 例 CO-CDI，估计 CO-CDI 的患病率为每 10000 人 1.29 例。所有 58 例病例均成功联系，应答率为 100%。由于合并感染沙门氏菌和弯曲杆菌，有 4 例病例被排除在进一步分析之外。病例更有可能为女性，年龄在 31 至 40 岁之间，且于 2009 年 3 月至 5 月的春季出现。46.3%（25/54）的病例有 CDI 的既定危险因素，20.4%（11/54）有非既定危险因素，16.7%（9/54）无危险因素，其余 16.7%（9/54）的病例的危险因素信息不足，无法进行分类。
本研究表明，对于有或无 CDI 既定危险因素的社区发病腹泻患者，均应将 CDI 纳入鉴别诊断。
