Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus

Highlights • 29% of cases of Clostridum difficile infection (CDI) at a large tertiary hospital campus in Sydney, Australia were of community onset. • Community onset Clostridum difficile infection has previously been considered to be a milder entitiy than hospital aquired infection but our study showed that markers of severity and outcomes were similar between the two groups. • Overall 30 day mortality for the two groups was 9%. • The community onset infection group were less likely to have the traditional risk factors of antibiotic use, proton pump inhibitor use or hospital contact. • Given the difficulties with predicting community onset infection using traditional risk factors, we recommend that all patients with diarrheoa being investigated in emergency departments and community practise are tested for Clostridium difficile infection.