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The incidence and clinical symptomatology of Clostridium difficile infections in a community setting in a cohort of Danish patients attending general practice

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Abstract

Clostridium difficile infection (CDI) is gradually being recognised as a cause of morbidity in the community. We investigated the incidence and clinical characteristics of CDI in a community setting and characterised the C. difficile strains by toxin gene profiling and polymerase chain reaction (PCR) ribotyping. Patients included in the study had attended general practice, primarily because of diarrhoea; CDI patients (259 patients; 121 <2 years of age) had positive cultures for toxigenic C. difficile and non-CDI patients (455 patients) were culture-negative. Outcome variables included the frequency and duration of diarrhoea, vomiting, stomach ache, fever >38 °C, weight loss and sick leave. Data were analysed by logistic regression. CDI patients <2 and ≥2 years of age with C. difficile as the only enteropathogen in the faecal sample reported slimy stools (65 % vs. 62 %), stomach ache (60 % vs. 75 %), weight loss (50 % vs. 76 %) and duration of diarrhoea >15 days (59 % vs. 73 %) as the predominant symptoms. CDI patients ≥2 years old reported duration of diarrhoea >15 days more often compared to non-CDI patients (73 % vs. 27 %, p < 0.0001). The annual incidence of CDI was 518 and 23/100,000 for patients <2 and ≥2 years of age, respectively, and 46/100,000 in the subgroup of patients ≥60 years of age. CDI was characterised by stomach ache and persistent diarrhoea, often leading to weight loss. This emphasises the importance of diagnosing CDI not only in hospitalised patients, but also in individuals ≥2 years of age attending general practice because of gastrointestinal symptoms, especially in the elderly, where the incidence of CDI is high.

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Acknowledgements

We thank all the laboratory technicians who participated in the stool sample analyses at Statens Serum Institut, Copenhagen, Denmark and Odense University Hospital, Odense, Denmark.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Microbiology and Infection Control, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark

    L. M. Søes, H. V. Nielsen, M. Torpdahl, E. M. Nielsen & K. E. P. Olsen

  2. Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark

    L. M. Søes, S. Ethelberg & K. Mølbak

  3. Department of Science, Systems and Models, Roskilde University, Universitetsvej 1, 4000, Roskilde, Denmark

    L. M. Søes & V. Andreasen

  4. Department of Clinical Microbiology, Odense University Hospital, J.B. Winsløws Vej 21, 2, 5000, Odense C, Denmark

    H. M. Holt & M. Kemp

  5. Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark

    B. Böttiger

  6. Department of Microbiology, Skåne University Hospital, Malmö, Sweden

    B. Böttiger

  7. Department of Clinical Microbiology, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark

    L. M. Søes

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  1. L. M. Søes
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Correspondence to L. M. Søes.

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Søes, L.M., Holt, H.M., Böttiger, B. et al. The incidence and clinical symptomatology of Clostridium difficile infections in a community setting in a cohort of Danish patients attending general practice. Eur J Clin Microbiol Infect Dis 33, 957–967 (2014). https://doi.org/10.1007/s10096-013-2033-3

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