Antimicrobial Agents and Clostridium difficile in Acute Enteric Disease: Epidemiological Data from Sweden, 1980-1982

Abstract

The carrier rate of Clostridium difficile in an adult Swedish population was found to be 11 (1.9%) of 594. All isolates were toxigenic in vitro, but no healthy individual harbored free cytotoxin in stool. Of 398 patients with acute diarrhea not associated with antibiotic use, cytotoxin was found in stool filtrates of four (1%). In 4,793 patients with antibiotic-associated diarrhea from all parts of Sweden during 1980-1982, C. difficile cytotoxin was demonstrated in 873 (18%). The tissue culture assay was found to be more specific than cultivation for the bacterium. By weighted analysis, in the age group greater than 70 years more women than men were infected. In the age group 21-50 years there was an even greater preponderance of infection in women than in men. Cephalosporins and lincosamides were 10-70 times more often implicated in C. difficile colitis than were narrow-spectrum penicillins.

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

“…CDAD is reportedly more common among older individuals (6,10,20,21,(24)(25)(26). In this study, 176 patients (67%) were older than age 65 years; this high proportion of older patients may reflect that there are larger numbers of elderly hospitalized patients or that older individuals are more susceptible to C difficile infections.…”

“…The CNISP study is the first Canadian, multicentre, national point prevalence project to examine N-CDAD. The rates of CDAD reported in other multicentre, national studies are not comparable because they are based on less specific definitions of CDAD (24)(25)(26)(27)(28).…”

“…Elderly individuals have decreased humoral immunity to C difficile (38), which may increase their susceptibility to C difficile infections. Furthermore, the National Corporation of Swedish Pharmacies has reported research findings that the increased consumption of antibiotics among the elderly is not always clearly correlated with the higher prevalence of CDAD infections (26).…”

“…Specific wards (eg, medical and surgical) where the rates of CDAD are higher are also more frequently studied (2,6,22,23). Multicentre and national surveillance of CDAD in North America and Europe is rare (24)(25)(26)(27)(28). In Canada, individual health centres have data on the prevalence and demographics of CDAD cases (6,9,21); however, no national data exist.…”

“…Many CDAD surveillance studies include community cases (16,17,(24)(25)(26)(27)(28); however, it is useful to examine specifically N-CDAD cases, because they represent illness that may be prevented by hospital infection prevention and control practices. The primary reservoirs of C difficile in the hospital are humans and the environment (29).…”