Diarrhea in elderly patients due to Clostridium difficile associated with Salmonella and Shigella infection

Clostridium difficile is the main cause of nosocomial diarrhea mainly in elderly hospitalized patients and in nursing homes, but less common in the community. We report three elderly patients living in the community, one frail and two in reasonable good health who recently developed diarrhea due to C. difficile associated with Salmonella group C in two cases and Shigella flexneri in the other. The association with Shigella has not previously been reported and there have only been a few cases with Salmonella. These findings may be important due to the possibility that diarrhea caused by C. difficile associated with other enteric bacteria may be more prevalent than expected in the aging population, thus necessitating awareness and consequently appropriate treatment and follow-up.