Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium difficile–Associated Disease

Abstract

Clostridium difficile infection, an important cause of nosocomial diarrhea, has also been reported to be an important cause of diarrhea in the community.^1-3 A British cohort study identified C difficile as the third most common cause of infectious diarrhea in patients aged 75 years and older seen by general practitioners.^4,5 A French prospective cohort study performed in outpatients to whom antibiotics were prescribed reported an incidence of C difficile–associated disease (CDAD) of 1.5% and estimated that up to 920 000 outpatients nationwide could potentially develop toxinogenic CDAD yearly.⁶ Recent data suggest that both the rates and severity of nosocomial CDAD are increasing.⁷ While the rates of CDAD in the community are much lower than in the hospital setting,^8-10 the absolute number of cases in the community could be significant.