Journal Article

A case–control study of community-associated Clostridium difficile infection

M. H. Wilcox, L. Mooney, R. Bendall, C. D. Settle and W. N. Fawley

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 62, issue 2, pages 388-396
Published in print August 2008 | ISSN: 0305-7453
Published online April 2008 | e-ISSN: 1460-2091 | DOI:

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The aim of this study was to determine the incidence of and risk factors for community-associated Clostridium difficile infection (CDI).


Prospective surveillance of community-derived faecal samples for C. difficile cytotoxin, followed by a questionnaire-based case–control study in two distinct patient cohorts (one semi-rural and the other urban).


The proportion of randomly selected faecal samples positive for C. difficile cytotoxin was 2.1% in both patient cohorts (median ages 73 and 45 years for the urban and semi-rural cohorts, respectively). Exposure to antibiotics in the previous 4 weeks, particularly multiple agents (P < 0.001), aminopenicillins (P < 0.05) and oral cephalosporins (P < 0.05), was significantly more frequent among cases than controls. Hospitalization in the preceding 6 months was significantly associated with CDI (45% versus 23%; P = 0.022). However, almost half the cases had not received antibiotic therapy in the month before C. difficile detection, and approximately one-third neither had exposure to antibiotics nor recent hospitalization. Contact with infants aged ≤2 years was significantly associated with CDI (14% versus 2%; P = 0.02). Prior exposure to gastrointestinal-acting drugs (proton pump inhibitor, H2 antagonist or non-steroidal anti-inflammatory) was not significantly more common in CDI cases. C. difficile PCR ribotype 001 caused 60% and 13% of urban and semi-rural community-associated CDI cases, respectively.


Reliance on antibiotic history and age (≥65 years) will contribute to missed diagnoses of community-associated CDI. Potential risk factors for community-associated CDI should be explored further to explain the large proportion of cases not linked to recent antibiotic therapy or hospitalization.

Keywords: antibiotics; diarrhoea; community-acquired

Journal Article.  4786 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care