Evaluation of Co-Infections among Patients with Community-Associated Clostridium difficile Infection
Though not considered common features of Clostridium difficile infection (CDI), patients with community-associated CDI (CA-CDI) often report nausea or vomiting. We evaluated the prevalence of co-infection with other gastrointestinal (GI) pathogens that cause nausea or vomiting and diarrhea among patients with CA-CDI to ascertain how frequently co-infection may contribute to CA-CDI illness.
We enrolled CA-CDI cases (C. difficile-positive stool specimen collected as an outpatient or within 3 days after admission from a person aged ≥1 year who did not have a positive assay ≤8 weeks and an overnight stay in a healthcare facility ≤ 12 weeks prior to stool collection) from December 1, 2012 – February 28, 2013 in 5 Emerging Infections Program sites participating in CDI surveillance. Demographic data, clinical data and GI bacterial pathogen testing were abstracted from medical records. C. difficile-positive stool specimens associated with case data were submitted for C. difficile culturing and RT-PCR for norovirus, rotavirus, sapovirus, astrovirus and adenovirus. Chi-square or Wilcoxon rank-sum tests were used to evaluate differences between co-infected and non-co-infected cases.
Of 187 CA-CDI cases enrolled, 14 (7.5%) tested positive for norovirus, 4 (2.1%) for enteric adenovirus, 3 (1.6%) for rotavirus, and 2 (1.1%) for sapovirus; one had a positive Campylobacter test. There were no significant differences between co-infected (n=24) and non-co-infected cases (n=163) with regards to age (median = 58 vs. 55, p=0.6), documentation of diarrhea (41% vs. 45%, p=0.7), nausea or vomiting (45% vs. 30%, p=0.1), antimicrobial exposure in the 12 weeks prior to specimen collection (41% vs. 57%, p=0.1), or detection of C. difficile by molecular assay (66% vs. 61%, p=0.6). Co-infected cases were less likely to be C. difficile-culture positive (66% vs. 88%, p=0.01) and to be North American Pulsed-Field type 1 (NAP1) (4% vs. 20%, p=0.03).
Although lower rates of C. difficile isolation and the NAP1 strain suggest co-infection could be a cause of C. difficile pseudoinfection in the community, this appears uncommon. Based on our data, clinical characteristics alone cannot differentiate these cases.
M. M. Farley, None
R. Perlmutter, None
S. M. Holzbauer, None
G. Dumyati, None
Z. G. Beldavs, None
A. L. Paulick, None
J. Vinje, None
B. Limbago, None
F. C. Lessa, None
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