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Antibiotics finding triggers call to widen c.difficile testing

Only half of cases of community-acquired Clostridium difficile infections are associated with recent antibiotic treatment, a study reveals

Researchers in Canada, where a well-established surveillance programme exists, found exposure to antibiotics raised risk of C. difficile but was not a pre-requisite.

The study has prompted calls to widen testing for patients with diarrhoea even in those without clear evidence of antibiotic exposure.

Researchers analysed 5,673 hospital admissions in the observational study, conducted over eight years between 1996 and 2004.

Exposure to antibiotics in the previous 45 days increased the risk of being admitted with C. difficile-associated diarrhoea by 10.6 times.

But 52.9% of the 836 patients admitted with C. difficile-associated diarrhoea had had no exposure to antibiotics in the 45 days before admission, and 382 none in the previous 90 days.

The study, published in the October issue of the Canadian Medical Association Journal, found a small increase, of 1.6 times, in risk associated with use of gastric acid suppressants and proton pump inhibitors.

Study leader Dr Sandra Dial, director of critical care medicine at McGill University in Montreal, said: ‘Testing for C. difficile should be considered in community patients with diarrhoea in whom a history of antibiotic exposure cannot be elicited.'

In an accompanying commentary, Dr Ed Kuijper a medical microbiologist at University Medical Center in Leiden, the Netherlands, said: ‘Because the absence of classic risk factors is unreliable for ruling out community-acquired C. difficile infection, it is worthwhile to test for C. difficile even in patients with diarrhea who have no known risk factors.

Health Protection Agency figures published in July show C. difficle infections in England rose by 6% to 140,586 – but fell 32% compared with the same quarter last year.

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