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Within hospitals, even outbreaks of diarrhea attributed to norovirus have been initially mis-attributed to C. Given these data, the pre-test suspicion for CDI in healthy outpatients without antimicrobial exposures remains low and should remain so even for outpatients with positive C.
Patients infected with this strain are reported to have lower clinical cure rates and higher rates of CDI recurrences than patients with other strains (216). Moreover, non-027 ribotype strains have been associated with severe clinical outcomes in at least two studies (221,222). In animals, some strains are species specific but others affect humans as well.