Outcomes of community and healthcare-onset clostridium difficile infections

Maria C. Mora Pinzon, Ronald Buie, Jinn Ing Liou, Daniel K. Shirley, Charlesnika T. Evans, Swetha Ramanathan, Linda Poggensee, Nasia Safdar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background Community-onset Clostridium difficile infections (CDI) are increasingly common, but there is little data on outcomes. The purpose of this study is to describe the epidemiology and outcomes of CDI in the Veterans Health Administration (VHA) system and compare these variables between hospital-onset (HCF) and community-onset (CO) cases. Methods We conducted a retrospective cohort study that included all patients with a positive test for C. difficile (toxin or toxin genes) within the VHA Corporate Data Warehouse between 2011 and 2014. Results We identified 19270 episodes of CDI, involving 15972 unique patients; 95% were male, 44% of the cases were HCF, and 42% were CO. Regarding severity, 31% percent of cases were non-severe, 40% were severe, and 21% were fulminant. Exposure to proton pump inhibitors was found in 53% of cases (47% in CO, 62% in HCF). Overall, 40% of patients received antibiotics in the 90 days before CDI (44% in HCF, 36% in CO). Recurrence was 18.2%, and 30-day all-cause mortality was 9.2%. Risk factors for a fulminant case were exposure to clindamycin (odds ratio [OR]: 1.23, P =.01) or proton pump inhibitors (OR: 1.20, P <.001) in the 90 days prior to diagnosis. Conclusions CO accounts for a significant proportion of CDI in the VHA system. CO patients are younger and their cases are less severe, but recurrence is more common than in HCF CDI. Therefore CO CDI may account for a considerable reservoir of CDI cases, and prevention efforts should include interventions to reduce CO CDI.

Original languageEnglish (US)
Pages (from-to)1343-1350
Number of pages8
JournalClinical Infectious Diseases
Volume68
Issue number8
DOIs
StatePublished - Apr 8 2019

Keywords

  • Clostridium difficile
  • community onset
  • outcomes
  • veteran affairs

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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