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Epidemic Clostridium difficile- Associated Diarrhea: Role of Second- and Third-Generation Cephalosporins

Published online by Cambridge University Press:  02 January 2015

David E. Nelson ,
Steven B. Auerbach ,
Aldona L. Baltch ,
Ethel Desjardin ,
Consuelo Beck-Sague ,
Carol Rheal ,
Raymond P. Smith  and
William R. Jarvis
David E. Nelson
Affiliation:
Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Steven B. Auerbach
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Aldona L. Baltch
Affiliation:
Department of Medicine, Section of Infectious Disease, Stratton Veterans Affairs Medical Center, Albany, New York
Ethel Desjardin
Affiliation:
Department of Medicine, Section of Infectious Disease, Stratton Veterans Affairs Medical Center, Albany, New York
Consuelo Beck-Sague
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Carol Rheal
Affiliation:
Department of Medicine, Section of Infectious Disease, Stratton Veterans Affairs Medical Center, Albany, New York
Raymond P. Smith
Affiliation:
Department of Medicine, Section of Infectious Disease, Stratton Veterans Affairs Medical Center, Albany, New York
William R. Jarvis*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Mailstop A-07, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30333
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Abstract

Objective:

To better define the role of multiple risk factors for cytotoxic Clostridium difficile-associated diarrhea.

Design:

Case-control study.

Setting:

A Veterans Affairs Medical Center.

Patients:

Thirty-three case patients with C difficile -associated diarrhea. Two control groups were used: one group consisted of 32 patients from the same ward as the case patients, and one group consisted of 34 patients with nosocomial diarrhea and negative C difficile toxin assays.

Intervention:

None.

Results:

Multivariate analyses revealed that exposure to second- or third-generation cepha-losporins was the most important independent risk factor, even after controlling for other antimicrobial use (odds ratio [OR]=8.3, 95% confidence interval [CI95] = 1.4 to 48.9 compared to ward controls; OR= 9.6, CI95 = 2.1 to 44.1 compared with diarrhea controls). Persons exposed to two or more antimicrobials simultaneously were at substantially elevated risk (OR= 18.7, CI95 = 4.1 to 85.8 compared with ward controls; OR=21.5, CI95=3.2 to 141.9 compared with diarrhea controls).

Conclusion:

Physicians should consider carefully the appropriateness of second- and third-generation cephalosporin use and combination antimicrobial therapy, especially during nosocomial C difficile -associated diarrhea outbreaks.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 2 , February 1994 , pp. 88 - 94
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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