Journal article
Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting
Annals of emergency medicine, Vol.70(1), pp.19-27
07/01/2017
DOI: 10.1016/j.annemergmed.2016.12.013
PMID: 28242058
Abstract
Study objective: The incidence of Clostridium difficile infection has increased and has been observed among persons from the community who have not been exposed to antibiotics or health care settings. Our aims are to determine prevalence of C difficile infection among emergency department (ED) patients with diarrhea and the prevalence among patients without traditional risk factors.
Methods: We conducted a prospective observational study of patients aged 2 years or older with diarrhea (>= 3 episodes/24 hours) and no vomiting in 10 US EDs (2010 to 2013). We confirmed C difficile infection by positive stool culture result and toxin assay. C difficile infection risk factors were antibiotic use or overnight health care stay in the previous 3 months or previous C difficile infection. We typed strains with pulsed-field gel electrophoresis.
Results: Of 422 participants, median age was 46 years (range 2 to 94 years), with median illness duration of 3.0 days and 43.4% having greater than or equal to 10 episodes of diarrhea during the previous 24 hours. At least one risk factor for C difficile infection was present in 40.8% of participants; 25.9% were receiving antibiotics, 26.9% had health care stay within the previous 3 months, and 3.3% had previous C difficile infection. Forty-three participants (10.2%) had C difficile infection; among these, 24 (55.8%) received antibiotics and 19 (44.2%) had health care exposure; 17 of 43 (39.5%) lacked any risk factor. Among participants without risk factors, C difficile infection prevalence was 6.9%. The most commonly identified North American pulsed-field gel electrophoresis (NAP) strains were NAP type 1 (23.3%) and NAP type 4 (16.3%).
Conclusion: Among mostly adults presenting to US EDs with diarrhea and no vomiting, C difficile infection accounted for approximately 10%. More than one third of patients with C difficile infection lacked traditional risk factors for the disease. Among participants without traditional risk factors, prevalence of C difficile infection was approximately 7%.
Details
- Title: Subtitle
- Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting
- Creators
- Fredrick M. Abrahamian - Los Angeles Medical CenterDavid A. Talan - Los Angeles Medical CenterAnusha Krishnadasan - Los Angeles Medical CenterDiane M. Citron - R. M. Alden Research Laboratory, Culver City, CAAshley L. Paulick - Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GALydia J. Anderson - Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GAEllie J. C. Goldstein - University of California, Los AngelesGregory J. Moran - Los Angeles Medical CenterEMERGEncy ID NET Study Group
- Resource Type
- Journal article
- Publication Details
- Annals of emergency medicine, Vol.70(1), pp.19-27
- Publisher
- Elsevier
- DOI
- 10.1016/j.annemergmed.2016.12.013
- PMID
- 28242058
- ISSN
- 0196-0644
- eISSN
- 1097-6760
- Number of pages
- 9
- Grant note
- CDC; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA Merck Pharmaceuticals; Merck & Company Optimer
- Language
- English
- Date published
- 07/01/2017
- Academic Unit
- Emergency Medicine; Internal Medicine
- Record Identifier
- 9984296970702771
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