Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium difficile–Associated Disease

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Abstract
Clostridium difficile infection, an important cause of nosocomial diarrhea, has also been reported to be an important cause of diarrhea in the community.1-3 A British cohort study identified C difficile as the third most common cause of infectious diarrhea in patients aged 75 years and older seen by general practitioners.4,5 A French prospective cohort study performed in outpatients to whom antibiotics were prescribed reported an incidence of C difficile–associated disease (CDAD) of 1.5% and estimated that up to 920 000 outpatients nationwide could potentially develop toxinogenic CDAD yearly.6 Recent data suggest that both the rates and severity of nosocomial CDAD are increasing.7 While the rates of CDAD in the community are much lower than in the hospital setting,8-10 the absolute number of cases in the community could be significant.