High incidence of Clostridium difficile associated diarrhoea with a community onset in a hyperendemic region in Germany
Abstract number: 1732_213
Weil H.P., Fischer-Brugge U., Harmanus C., Mattner F., Gastmeier P., Kuijper E.J.
Background: Recent studies from UK and USA suggest an increase of community-acquired CDAD, possible associated with use of proton pump inhibitors (PPI).
Objectives: To investigate the incidence of CDAD among patients with diarrhoea visiting the general practitioner and using the proposed definitions of European Center of Disease Control and Prevention.
Methods: All faeces samples of patients with diarrhoea submitted by general practitioners were investigated for CDAD by an enzyme-immunoassay for C. difficile toxin A/B. Positive samples were cultured for the presence of C. difficile. Isolates were typed by PCR ribotyping. Standardised questionnaires were used to obtain clinical data and patient information using ICD-10 classification.
Results: Of 703 faeces samples submitted in a 6 months period in 2006, 34 (4.8%) contained Salmonella enteritica and 21 (3%) Campylobacter. Giardia lamblia and Yersinia enterocolitica were isolated in 2 and 1 patients, respectively. C. difficile was detected in 66 (9.3%) of all faeces samples; 13 (26%) patients had moderatesevere diarrhoea and 53 (74%) suffered from mild diarrhoea. Of 66 patients with community-onset CDAD, 31 (47%) were healthcare-associated (onset of symptoms within 48 h following admission or within 4 weeks after discharge) and 53% were community-associated. The mean age of 66 patients (24 males and 41 females) with CDAD was 66 years. The most frequent underlying diseases were cardiovascular disease (41%), urogenital disease (20%), lung disease (14%), diabetes mellitus (11%) and malignancy (9%). Recent antibiotic use was reported by 34 (52%) patients with cephalosporins (33%) and fluoroquinolones (33%) as most frequently. Of 66 patients, 19 (29%) received a PPI and 17 (26%) NSAID. Preliminary results of typing of 14 strains revealed 8 different types with type 001 (21%) and type 015 (14%) as the predominant types.
Conclusion:Clostridium difficile was the most frequent cause of diarrhoea in a population of patients who visited the GP because of diarrhoea, but 47% was healthcare-associated.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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