Poster Presentation Australian Society for Microbiology Annual Scientific Meeting 2016

Clostridium difficile infection in emergency department patients in Western Australia (#207)

Deirdre A Collins 1 , Linda Selvey 2 , Antonio Celenza 3 , Thomas V Riley 1 4
  1. School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia
  2. School of Public Health, Curtin University, Bentley, WA, Australia
  3. School of Primary, Aboriginal and Rural Healthcare, University of Western Australia, Crawley, WA, Australia
  4. Department of Microbiology, PathWest Laboratory Medicine (WA), Nedlands, WA, Australia

Background

Clostridium difficile infection (CDI) is primarily thought of as a hospital-associated infection (HA-CDI), however community-associated CDI (CA-CDI) has increased over recent years, particularly in Australia. Moreover, new strains of C. difficile, such as ribotype (RT) 244, have emerged in recent years associated with CA-CDI and severe disease. We aimed to investigate the epidemiology of CA-CDI in Western Australia (WA).

Methods

A retrospective study was performed for patients infected either with C. difficile or another bacterial diarrhoeal pathogen at six hospital emergency departments in WA from July 2013 to June 2014. Information was collected on clinical signs, recent medication and hospitalisations. Descriptive characteristics were calculated and odds ratios (ORs) for risk factors for CA-CDI were determined by logistic regression.

Results

A total of 77 CDI cases and 77 controls infected with another pathogen including Campylobacter spp. (n=46), Salmonella spp. (n=12) and Aeromonas spp. (n=4) were included. Elevated white cell count (WCC; 33.8% vs 8.0%, p<0.01), age ≥65 years (48.1% vs 19.5%, p<0.01) and previous antimicrobial use (45.5% vs 11.7%, p<0.01) were significantly more frequent among CDI cases.

CA-CDI was present in 44.2% of CDI cases. CA-CDI cases were significantly younger than HA-CDI cases (35.3% vs 7.9% aged 18-35 y, p<0.01). Risk factors for CA-CDI were liver disease (19.05, p<0.05) and previous antibiotic use (7.31, p<0.001). Six CDI cases with signs of severe CDI (elevated WCC or SC) were not admitted for further treatment.

RT 014/020 was most common (45.5%) among 66 C. difficile isolates available for ribotyping followed by RTs 002 (7.6%), 001, 056 and 244 (all 4.5%).

Conclusions

CA-CDI was highly prevalent among emergency department patients. CA-CDI cases were significantly younger than other CDI cases. Vigilance is required among emergency department medical personnel to rapidly identify and treat CDI patients. RT 244 was among the most common C. difficile strains isolated, indicating persistence in the community since its emergence in 2010-2011.