Ann Clin Microbiol.  2016 Mar;19(1):7-12. 10.5145/ACM.2016.19.1.7.

Increase of Clostridium difficile in Community; Another Worrisome Burden for Public Health

• Kim YA
• Rim JH
• Choi MH
• Kim H
• Lee K

• KMID: 2160079
• DOI: http://doi.org/10.5145/ACM.2016.19.1.7

Abstract

BACKGROUND
Increasing rates of Clostridium difficile infection (CDI) have been reported mainly in Europe and North America; however, only limited reports have originated in Korea. The current epidemiology of CDI in the community could help to understand the outpatient healthcare environment and to extend infection control measures to outpatient settings.
METHODS
C. difficile isolates in NHIS Ilsan Hospital from 2012 to 2014 were included in this study. Clinical characteristics, acquisition types, and previous antimicrobial therapy were obtained via Electronic Medical Records. C. difficile culture was performed only in unformed stool. Toxin was positive by enzyme-linked fluorescent immunoassay (ELFA) in 247 specimens. In addition, toxin B and binary toxin gene were detected by PCR in 57 specimens. CDI was defined by toxigenic C. difficile isolation in unformed stool.
RESULTS
In the previous 3 years, 251 unduplicated C. difficile cases have been detected; 168 healthcare facility- associated hospital onset (HCFA-HO), 45 healthcare facility-associated community onset (HCFA-CO), and 38 community-associated (CA). Toxin positive rates by ELFA for toxin A&B were HCFA-HO 50.6% (84/166), HCFA-CO 41.9% (18/43), and CA 42.1% (16/38). Toxin positive rate by PCR for tcdB were HCFA-HO 62.9% (22/35), HCFA-CO 69.2% (9/13), and CA 100% (9/9). No binary toxin (cdtA/cdtB) was detected in 57 cases.
CONCLUSION
Community-associated CDI may be underestimated in Goyang province, Korea, especially by commonly used ELFA toxin assay. The spread of community-associated CDI should be recognized as an increasing burden of public health.

Keyword

Clostridium difficile toxin B; Community-acquired infection; Epidemiology

MeSH Terms

Clostridium difficile*
Clostridium*
Community-Acquired Infections
Delivery of Health Care
Electronic Health Records
Epidemiology
Europe
Humans
Immunoassay
Infection Control
Korea
North America
Outpatients
Polymerase Chain Reaction
Public Health*

Figure

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  Fig. 1. Clostridium difficile isolates from unformed stool (CDI or colonization): Number and proportion of isolates (total 251 unduplicated isolates). Abbreviations: CDI, Clostridium difficile infection; HCFA-HO, healthcare facility-associated hospital onset; HCFA-CO, healthcare facility-associated community onset; CA, community-associated community onset.

Reference

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