Community-acquired, antibiotic-unassociated Clostridium difficile colitis: Report of four patients

Over a 14-month period, four patients were admitted to a 392-bed teaching hospital with community-acquired, antibiotic-unassociated Clostridium difficile colitis. Three of these elderly patients (mean age, 74 years; three of four, women; three of four, without significant underlying diseases), were convinced that food prepared outside of their homes precipitated their diarrheal illnesses. An evaluation of all cases of C. difficile-associated diarrhea and colitis in patients admitted to the hospital in 1995 revealed an incidence of 0.2/1000 admissions for community-acquired illness and an incidence of 6.6/1000 discharges for nosocomial disease; 50% of the former and 1% of the latter were cases unrelated to the use of antiinfective drugs. Although not common, antibiotic-unassociated C. difficile-induced disease should be considered in the assessment of an adult presenting to the hospital with a community-acquired, inflammatory enterocolitis.