Community-associated Clostridium difficile infection in emergency department patients in Western Australia

Deirdre A. Collins, Linda A. Selvey, Antonio Celenza, Thomas V. Riley

Research output: Contribution to journalArticle

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Abstract

Clostridium difficile infection (CDI) is primarily associated with hospitalised patients, however, community-associated CDI (CA-CDI) has increased in Australia. We aimed to investigate the epidemiology and outcomes of CA-CDI cases presenting to hospital emergency departments in Western Australia (WA). A retrospective case-control study of CA-CDI cases presenting at six emergency departments in WA from July 2013 to June 2014 was performed. Clinical signs, recent medication, hospitalisations and potential risk factors for CA-CDI were investigated for cases (n = 34) and unmatched controls (n = 62) who were infected with another gastrointestinal pathogen, including Campylobacter spp., Salmonella spp., Aeromonas spp., Shigella sonnei and Escherichia coli O157. Elevated white cell count (31.3% vs 8.2%, p < 0.01), female gender (67.6% vs 41.9%, p < 0.05), age ≥65 years (41.2% vs 21.0%, p < 0.05) and antimicrobial use in the previous month (41.2% vs 11.3%, p < 0.01) were significantly more frequent among cases compared to controls. After multivariable analysis, antibiotic use (odds ratio 8.49, 95% confidence interval 2.75–26.21) and age ≥65 years (3.03, 1.05–8.75) were significantly associated with CA-CDI. Ribotype (RT) 014/020 was most common (40.7%) among 27 C. difficile isolates followed by RTs 002 (14.8%), 001, 056 and 244 (all 7.4%). CA-CDI was associated with advanced age and recent antibiotic use compared to those infected with other gastrointestinal pathogens. RT 014 has also recently been found at high prevalence in public lawn spaces, and previously RT 014 strains from humans and pigs in Australia were closely genetically related, suggesting CA-CDI may be linked with these community reservoirs.

LanguageEnglish
Pages121-125
Number of pages5
JournalAnaerobe
Volume48
DOIs
StatePublished - 1 Dec 2017

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Clostridium Infections
Western Australia
Clostridium difficile
Hospital Emergency Service
Ribotyping
Shigella sonnei
Anti-Bacterial Agents
Aeromonas
Campylobacter
Escherichia coli O157
Hospital Departments
Salmonella
Case-Control Studies
Epidemiology
Hospitalization
Swine
Cell Count
Odds Ratio
Confidence Intervals

Cite this

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title = "Community-associated Clostridium difficile infection in emergency department patients in Western Australia",
abstract = "Clostridium difficile infection (CDI) is primarily associated with hospitalised patients, however, community-associated CDI (CA-CDI) has increased in Australia. We aimed to investigate the epidemiology and outcomes of CA-CDI cases presenting to hospital emergency departments in Western Australia (WA). A retrospective case-control study of CA-CDI cases presenting at six emergency departments in WA from July 2013 to June 2014 was performed. Clinical signs, recent medication, hospitalisations and potential risk factors for CA-CDI were investigated for cases (n = 34) and unmatched controls (n = 62) who were infected with another gastrointestinal pathogen, including Campylobacter spp., Salmonella spp., Aeromonas spp., Shigella sonnei and Escherichia coli O157. Elevated white cell count (31.3{\%} vs 8.2{\%}, p < 0.01), female gender (67.6{\%} vs 41.9{\%}, p < 0.05), age ≥65 years (41.2{\%} vs 21.0{\%}, p < 0.05) and antimicrobial use in the previous month (41.2{\%} vs 11.3{\%}, p < 0.01) were significantly more frequent among cases compared to controls. After multivariable analysis, antibiotic use (odds ratio 8.49, 95{\%} confidence interval 2.75–26.21) and age ≥65 years (3.03, 1.05–8.75) were significantly associated with CA-CDI. Ribotype (RT) 014/020 was most common (40.7{\%}) among 27 C. difficile isolates followed by RTs 002 (14.8{\%}), 001, 056 and 244 (all 7.4{\%}). CA-CDI was associated with advanced age and recent antibiotic use compared to those infected with other gastrointestinal pathogens. RT 014 has also recently been found at high prevalence in public lawn spaces, and previously RT 014 strains from humans and pigs in Australia were closely genetically related, suggesting CA-CDI may be linked with these community reservoirs.",
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Community-associated Clostridium difficile infection in emergency department patients in Western Australia. / Collins, Deirdre A.; Selvey, Linda A.; Celenza, Antonio; Riley, Thomas V.

In: Anaerobe, Vol. 48, 01.12.2017, p. 121-125.

Research output: Contribution to journalArticle

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T1 - Community-associated Clostridium difficile infection in emergency department patients in Western Australia

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AU - Selvey,Linda A.

AU - Celenza,Antonio

AU - Riley,Thomas V.

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AB - Clostridium difficile infection (CDI) is primarily associated with hospitalised patients, however, community-associated CDI (CA-CDI) has increased in Australia. We aimed to investigate the epidemiology and outcomes of CA-CDI cases presenting to hospital emergency departments in Western Australia (WA). A retrospective case-control study of CA-CDI cases presenting at six emergency departments in WA from July 2013 to June 2014 was performed. Clinical signs, recent medication, hospitalisations and potential risk factors for CA-CDI were investigated for cases (n = 34) and unmatched controls (n = 62) who were infected with another gastrointestinal pathogen, including Campylobacter spp., Salmonella spp., Aeromonas spp., Shigella sonnei and Escherichia coli O157. Elevated white cell count (31.3% vs 8.2%, p < 0.01), female gender (67.6% vs 41.9%, p < 0.05), age ≥65 years (41.2% vs 21.0%, p < 0.05) and antimicrobial use in the previous month (41.2% vs 11.3%, p < 0.01) were significantly more frequent among cases compared to controls. After multivariable analysis, antibiotic use (odds ratio 8.49, 95% confidence interval 2.75–26.21) and age ≥65 years (3.03, 1.05–8.75) were significantly associated with CA-CDI. Ribotype (RT) 014/020 was most common (40.7%) among 27 C. difficile isolates followed by RTs 002 (14.8%), 001, 056 and 244 (all 7.4%). CA-CDI was associated with advanced age and recent antibiotic use compared to those infected with other gastrointestinal pathogens. RT 014 has also recently been found at high prevalence in public lawn spaces, and previously RT 014 strains from humans and pigs in Australia were closely genetically related, suggesting CA-CDI may be linked with these community reservoirs.

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