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Clinical and epidemiologic features of community versus hospital-acquired Clostridium difficile infection


Clostridium difficile infection (CDI) is an increasingly common hospital-associated infection. There is an increasing awareness in recent years about the impact of community-acquired Clostridium difficile infection (CA-CDI).


We enrolled all CDI patients admitted to the Adults III department of the National Institute for Infectious Diseases "Prof. Dr. Matei Balş", Bucharest, between January – July 2014. Stool culture, toxin EIA and Cepheid Gene Xpert C. difficile test were used for CDI diagnosis. The subjects were divided into two groups: CA-CDI patients (Group 1) and HA-CDI patients (Group 2). Our objective was to describe the clinical, epidemiologic features and outcome of CA-CDI compared to hospital-associated CDIs (HA-CDI) including the ATLAS bedside severity scoring system. Statistical analyses were performed using SPSS Statistics package v.17.


We included 57 patients with median age 69 years (IQR =54;78). Male/female ratio was 0.72. Most patients (75.4%) presented with an initial CDI episode, the rest having the first (17.5%) or next (2-5) (7%) recurrences. The median value of ATLAS score was 3 (IQR=2;4). Most patients (87.7%) had previously received antibiotic therapy. In 15.8% cases cancer had been previously diagnosed and 17.5% of patients had had recent surgery. Clostridium difficile 027 strain was identified in almost all patients.

The patients were treated with vancomycin (73.7%), metronidazole (12.3%), vancomycin/metronidazole association (10.3%); 3.5% received tigecycline. Nine patients (15.8%) were included in the CA-CDI and forty-eight patients (84.2%) had HA-CDI. The number of CA-CDI in the first 7 months of 2014 was about two times higher than in 2013. Group 1 had fewer comorbidities, were younger (median 52 years (IQR 34.5;77) vs. 69.50 years (IQR 55.25;78), p=0.164, had more mild CDI episode (55.6% vs. 33.3%, p=0.26), all had received antibiotics and two cases received proton pomp inhibitors.

Group 1 received more aminopenicillins (33.3%) and less CEPH (11.1%) compared to Group 2 (2.1% and 18.8%, respectively, p=0.06 and p=1). FQ use was similar: 22.2% in Group 1 vs. 18.8% in Group 2. There was one death in HA-CDI. There were no statistical differences between the two groups regarding: sex distribution, median ATLAS score – 3, rates of complicated/recurrent CDI and use of vancomycin or metronidazole treatment.


Approximately one sixth of CDIs were CA-CDI. These patients were younger, had predominant mild CDI and received more frequently aminopenicillins than those with HA-CDI. We found no significant differences between the two groups regarding Clostridium difficile 027 strain prevalence and infection severity.

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Correspondence to Violeta Molagic.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Molagic, V., Lăpădat, I., Mihăilescu, R. et al. Clinical and epidemiologic features of community versus hospital-acquired Clostridium difficile infection. BMC Infect Dis 14 (Suppl 7), O25 (2014).

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