In a largely adult population, those presenting to the ED with diarrhea only and no vomiting had C. difficile colitis as the cause in 10%, and almost 40% lacked risk factors.
Why does this matter?
We could easily consider these cases to be viral. If a patient has a severe diarrheal illness and lacks vomiting, consider C. difficile. This could change your management and require contact isolation if hospitalized.
This was a prospective study in 10 US EDs with patients age 2 through adult, median age 46, with isolated diarrhea and no vomiting. Of 422 patients, 10% had C. difficile as the cause. Of patients with C. difficile, 17/43 (39.5%) had no risk factors: antibiotic exposure, overnight hospital stay, or prior C. difficile infection. This was a convenience sample, which could have introduced selection bias. In fact, 663 eligible patients were not enrolled, so these findings almost certainly overestimate the prevalence of C. difficile infection.
Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting. Ann Emerg Med. 2017 Jul;70(1):19-27.e4. doi: 10.1016/j.annemergmed.2016.12.013. Epub 2017 Feb 24.
Peer reviewed by Thomas Davis, MD.