Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6710
Revised: September 12, 2013
Accepted: September 15, 2013
Published online: October 28, 2013
Once a nosocomial disease, Clostridium difficile infection (CDI) now appears frequently in the community in the absence of exposure to antibiotics. Prior studies have shown that patients with community-acquired CDI are younger, more likely to be female, and have fewer comorbidities compared to patients with hospital-associated CDI. Because most studies of CDI are hospital-based, comparatively little is known about community-acquired CDI. The recent study by Chitnis has received widespread attention because it used active surveillance to capture all cases of community-acquired CDI within a large population and assessed key risk factors. The authors found that low-level healthcare exposure and proton pump inhibitor use were common among those with non-antibiotics associated, community-acquired CDI. In this commentary, we discuss the changing epidemiology of community-acquired CDI and the evidence basis for the controversial association between proton pump inhibitors and community-acquired CDI.
Core tip: Population-based studies demonstrate that non-antibiotic associated, community-acquired Clostridium difficile infection (CDI) is increasingly common. Patients with community-acquired CDI are younger and have fewer comorbidities compared to patients with hospital-associated CDI. Proton pump inhibitors may be a risk factor for non-antibiotic associated, community-acquired CDI.