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One in four C. difficile cases diagnosed in the community

By Lilian Anekwe

Nearly a quarter of cases of Clostridium difficile are now being diagnosed in the community, mostly by GPs, an analysis reveals.

The study estimated where C. difficile infections recorded through hospital-based surveillance programmes were actually acquired. It found 23% were diagnosed in a community setting.

The Health Protection Agency researchers also estimated that half of the cases diagnosed in the community were true community-onset cases, as opposed to infections picked up in hospitals.

The results suggest that despite the successes of the hospital-based surveillance programme, which has seen large reductions in the number of C. difficile infections, community-associated infections may be going largely ignored.

In October, the number of reported cases of C. difficile fell by 18% in the previous quarter and by 38% on the same period the year before, to 8,683.

The study, presented at the European Congress of Clinical Microbiology and Infectious Diseases in Helsinki, Finland, this week, analysed more than 75,000 UK cases of C. difficile infections in patients aged two or older reported since the mandatory surveillance scheme began in April 2007. Some 23% of these were community associated, with 74% of samples in non-acute settings taken by GPs.

Lead researcher Dr Andrew Pearson, the HPA's deputy director of healthcare associated infections and antimicrobial resistance, said: ‘Some 23% of the C. difficile specimens reported by acute trusts were diagnosed in a community setting and 12-15% of these were community-onset, but hospital-acquired, cases.'

Dr Pearson said the HPA would now start investigating how previous antibiotic exposure affected the risk of community-onset infections.

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