Epidemiology of Community-Acquired Clostridium difficile-Associated Diarrhea

• Published in: The Journal of infectious diseases Vol. 169; no. 1; pp. 127 - 133
• Main Authors: Hirschhorn, Lisa R., Trnka, Yvona, Onderdonk, Andrew, Lee, Mei-Ling T., Platt, Richard
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.01.1994; University of Chicago Press
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Antibiotics; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Boston - epidemiology; Chi-Square Distribution; Child; Child, Preschool; Clostridium difficile; Cohort Studies; Colitis; Diarrhea; Disease transmission; Drug prescriptions; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - etiology; Female; Health Maintenance Organizations; HIV; Hospitalization; Human bacterial diseases; Humans; Incidence; Infant; Infectious diseases; Major Articles; Male; Medical sciences; Middle Aged; Penicillin; Pharmacies; Retrospective Studies; Risk Factors; Sex Factors; Toxins; Boston; Human; Toxicity; Clostridium difficile; Sex; Clostridiales; Diarrhea; Epidemiology; Retrospective; Antibiotic; Treatment; Cohort study; Clostridiaceae; Risk factor; Digestive diseases; Bacteria; Intestinal disease; Age
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/169.1.127

The epidemiology of clinically recognized community-acquired Clostridium difficile-associated diarrhea was assessed in a retrospective cohort study of members of a health maintenance organization (HMO). Potential cases were identified through positive toxin assay results and confirmed by review of automated full-text medical records. Of 51 cases identified (7.7 per 100,000 person-years), 42 (82%) were diagnosed and treated exclusively in the ambulatory care setting; 33 cases occurred within 42 days after 494,491 exposures to antibiotics dispensed by an HMO pharmacy. Antibiotic-specific attack rates varied from 0 to 2040 cases per 100,000 exposures. Increased age was associated with C. difjiciie-associated diarrhea (P < .001). Age-adjusted antibiotic-specific attack rates were at least 10-fold higher (P < .05) for nitrofurantoin, cefuroxime, cephalexin plus dicloxacillin, ampicillinjclavulanate plus cefaclor, and ampicillin/clavulanate plus cefuroxime than for ampicillin or amoxicillin; several other antibiotics were associated with similar but not significantly increased risks.