Epidemiology and Infection

Original Papers

Other gastrointestinal

Risk factors for Clostridium difficile infection in the community: a case-control study in patients in general practice, Denmark, 2009–2011

L. M. SØESa1a2a3 c1, H. M. HOLTa4, B. BÖTTIGERa5a6, H. V. NIELSENa1, V. ANDREASENa3, M. KEMPa4, K. E. P. OLSENa1, S. ETHELBERGa2 and K. MØLBAKa2

a1 Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark

a2 Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark

a3 Department of Science, Systems and Models, Roskilde University, Roskilde, Denmark

a4 Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark

a5 Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark

a6 Department of Microbiology, Skåne University Hospital, Malmö, Sweden


To identify risk factors for Clostridium difficile infection (CDI) in Danish patients consulting general practice with gastrointestinal symptoms, a prospective matched case-control study was performed; cases (N = 259) had positive cultures for toxigenic C. difficile and controls (N = 455) negative cultures. Data were analysed by conditional logistic regression. In patients aged ≥2 years (138 cases), hospitalization [odds ratio (OR) 8·4, 95% confidence interval (CI) 3·1–23], consumption of beef (OR 5·5, 95% CI 2·0–15), phenoxymethylpenicillin (OR 15, 95% CI 2·7–82), dicloxacillin (OR 27, 95% CI 3·6–211), and extended spectrum penicillins (OR 9·2, 95% CI 1·9–45) were associated with CDI. In patients aged <2 years none of these were associated with CDI, but in a subgroup analysis contact with animals was associated with CDI (OR 8·1, 95% CI 1·0–64). This study emphasizes narrow-spectrum penicillins, and suggests beef consumption, as risk factors for CDI in adults, and indicates a different epidemiology of CDI in infants.

(Received April 06 2013)

(Revised August 23 2013)

(Accepted August 30 2013)

(Online publication September 27 2013)

Key words

  • Antibiotics;
  • case-control study;
  • children;
  • community-associated Clostridium difficile infection;
  • zoonoses


c1 Author for correspondence: Ms. L. M. Søes, Department of Clinical Microbiology, Hvidovre Hospital, Kettegård Alle 30, DK-2650 Hvidovre, Denmark. (Email: lillian_soees@dadlnet.dk)