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

Young Ah Kim; John Hoon Rim; Min Hyuk Choi; Heejung Kim; Kyungwon Lee

doi:10.5145/ACM.2021.19.1.13

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Kim, Rim, Choi, Kim, and Lee: Increase of Clostridium difficile in Community; Another Worrisome Burden for Public Health

Original Article

Ann Clin Microbiol 2016;19(1):7-12.

Published online: 12 March 2016

DOI: https://doi.org/10.5145/ACM.2021.19.1.13

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

Young Ah Kim¹, John Hoon Rim², Min Hyuk Choi², Heejung Kim², Kyungwon Lee²

^¹Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea

^²Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

Correspondence: Heejung Kim, Department of Laboratory Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, 225 Geumhak-ro, Cheoin-gu, Yongin 17046, Korea. (Tel) 82-31-331-8755, (Fax) 82-31-335-5551, (E-mail) hjkim12@yuhs.ac

Received 6 October 2015 Revised 6 January 2016 Accepted 7 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.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 fa-cility-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.detected in 57 cases. Conclusion: Community-associated CDI may be un-derestimated 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. (Ann Clin Microbiol 2016;19:7–12)

Keywords: Clostridium difficile toxin B, Community-acquired infection, Epidemiology

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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.

Table 1.

Antimicrobial uses of Clostridium difficile in community onset (HCFA-CO and CA) groups

Type of infection		HCFA-CO	CA	P*
Previous antimicrobial (%)		82.2 (37/45)	23.7 (9/38)	0.00
More than three classes (%)		24.3 (9/37)	0 (0/9)	0.01
Penicillin β-lactam/inhibitors	Amoxicillin Ampicillin-sulbactam	312	2 4
	Piperacillin-tazobactam
	Cefoperazone-sulbactam
1st or 2nd cephalosporin	Cefazolin, cefimox, cefixime, cefotetan, cefodoxime	21	2
	Cefdinir, cefadroxil
3 ^rd cephalosporin	Cetazidime, ceftraixone	17	0
Carbapenem	Imipenem, meropenem, doripenem	4	1
Fluoroquinolones	Levofloxacin, ciprofloxacin, gemifloxacin, moxifloxacin	19	4
Aminoglycoside	Isepamycin, amikacin	4	0
Glycylcyclines	Tigecycline	2	1
Separately counted all antibiotics.
*χ² square.

Abbreviations: HCFA-CO, healthcare facility-associated community onset; CA, community-associated community onset.

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