Summary
The key point in this article is that the author shows a connection between Community Acquired clostridium difficile infections & lack of antimicrobial use. For example, the widespread use of ant-acids ie; proton pump inhibitors. This article is helpful because delineating some of the risk factors may help curb this deadly disease. However, make no mistake there is a very clear link between hospital or nosocomial transmission & antibiotic use. All patients with diarrhea requiring hospital admission (especially with a profoundly elevated white blood cell count) should be tested for C. difficile.
Analysis
This finding should alert emergency departments & primary care providers to alter their epidemiological clues & screening techniques in several ways. The assumption that if there is no history of antimicrobial use & the patient requires admission that C. difficile infection is unlikely is obviously false. There are new & very sensitive screening tests available that can detect the possibility of infection within 2 hours & thus would dramatically alter the way the healthcare system starts the work up for infectious diarrhea right in the emergency department for example. More studies are needed to clarify community risk factors & perhaps these would also be a marker for disease risk in the future instead of antibiotic use in the healthcare experienced patients.
