Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology


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pISSN 2288-0585 eISSN 2288-6850

Increase of Clostridium difficile in Community; Another Worrisome Burden for Public Health

Original article

Annals of Clinical Microbiology (Ann Clin Microbiol) 2016 March, Volume 19, Issue 1, pages 7-12.

Increase of Clostridium difficile in Community; Another Worrisome Burden for Public Health

Young Ah Kim1, John Hoon Rim2, Min Hyuk Choi2, Heejung Kim2, Kyungwon Lee2
1Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, 2Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea


Background: Increasing rates of Clostridium difficile infection (CDI) have been reported mainly in Europe and North America; however, only limited reports have originated in Korea. The current epidemiology of CDI in the community could help to understand the outpatient healthcare environment and to extend infection control measures to outpatient settings.

Methods: C. difficile isolates in NHIS Ilsan Hospital from 2012 to 2014 were included in this study. Clinical characteristics, acquisition types, and previous antimicrobial therapy were obtained via Electronic Medical Records. C. difficile culture was performed only in unformed stool. Toxin was positive by enzyme-linked fluorescent immunoassay (ELFA) in 247 specimens. In addition, toxin B and binary toxin gene were detected by PCR in 57 specimens. CDI was defined by toxigenic C. difficile isolation in unformed stool.

Results: In the previous 3 years, 251 unduplicated C. difficile cases have been detected; 168 healthcare facility-associated hospital onset (HCFA-HO), 45 healthcare facility-associated community onset (HCFA-CO), and 38 community-associated (CA). Toxin positive rates by ELFA for toxin A&B were HCFA-HO 50.6% (84/166), HCFA-CO 41.9% (18/43), and CA 42.1% (16/38). Toxin positive rate by PCR for tcdB were HCFA-HO 62.9% (22/35), HCFA-CO 69.2% (9/13), and CA 100% (9/9). No binary toxin (cdtA/cdtB) was detected in 57 cases.

Conclusion: Community-associated CDI may be underestimated in Goyang province, Korea, especially by commonly used ELFA toxin assay. The spread of community-associated CDI should be recognized as an increasing burden of public health. (Ann Clin Microbiol 2016;19:7-12)


Clostridium difficile toxin B, Community- acquired infection, Epidemiology