Community-acquired Clostridium difficile infection

The Gram-positive anaerobic bacterium Clostridium difficile is transmitted by the fecal-oral route.1,2 Clostridium difficile infection (CDI) can cause illness ranging from diarrhea to colitis, toxic megacolon, and death. The incidence in the United States has doubled since the 1990s, to 95.3 cases per 100 000 in acute care settings.3,4 The classic risk factors include recent antibiotic use, recent hospitalization, and old age. Clostridium difficile is responsible for 15% to 25% of antibiotic-associated diarrhea.2 Recent studies have suggested dramatic changes in the epidemiology of CDI.3–6 Members of community populations are acquiring CDI who were previously thought to be at low risk. Community-acquired CDI is defined as the onset of symptoms within 48 hours of admission to hospital or more than 12 weeks after discharge. This case report presents an important paradigm shift: C difficile can no longer be viewed solely as a hospital-acquired infection