Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-05T13:48:49.509Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors forClostridium difficile Toxin-Associated Diarrhea

Published online by Cambridge University Press:  21 June 2016

Elizabeth Brown ,
George H. Talbot ,
Peter Axelrod ,
Mary Provencher  and
Cindy Hoegg
Elizabeth Brown
Affiliation:
Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
George H. Talbot*
Affiliation:
Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Infection Control Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Peter Axelrod
Affiliation:
Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Mary Provencher
Affiliation:
Infection Control Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Cindy Hoegg
Affiliation:
Infection Control Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
*
One Gibson Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
Get access Rights & Permissions [Opens in a new window]

Abstract

The hospital-wide attack rate for Clostridium difficile-associated diarrhea at our tertiary-care university hospital was 0.02 per 100 patient discharges (0.02%) in 1982, but 0.41% and 1.47% in 1986 and 1987, respectively, with a peak incidence of 2.25% in the fourth quarter of 1987. Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole. Thirty-seven cases selected for study were older than 37 control patients, more likely to have an underlying malignancy and less likely hospitalized on the obstetrics/gynecology service. Their mean duration of hospitalization prior to diagnosis was 21 days, versus a mean total length of stay of eight days for controls. All cases received antibiotics, compared to 24 of the controls. Cases were given more antibiotics for longer periods, and more often received clindamycin, third-generation cephalosporins, aminoglycosides and vancomycin. Gender, race, duration of hospitalization, prior surgery and antiulcer therapy were not significant by logistic regression analysis. Epidemiologic variables with significantly different adjusted odds ratios (95% confidence intervals) were age greater than 65 years (14.1, 1.4-141), intensive care unit residence (39.2, 2.2-713), gastrointestinal procedure (23.2, 2.1-255) and more than ten antibiotic days (summation of days of each antibiotic administered) (16.1, 2.2-117). Control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronidazole for therapy of anaerobic infections. By the second half of 1988, the attack rate had dropped progressively to 0.74%.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 6 , June 1990 , pp. 283 - 290
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bartlett, JG, Chang, TW, Gurwith, M, Gorbach, SL, Onderdonk, AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing Clostridia. N Engl J Med. 1978;298:531–534.CrossRefGoogle ScholarPubMed
2. George, RH, Symonds, JM, Dimock, F, et al. Identification of Clostridium difficile as a cause of pseudomembranous colitis. Br Med J. 1978;1:695.CrossRefGoogle ScholarPubMed
3. Bartlett, JG, Chang, TW, Taylor, NS, Onderdonk, AB. Colitis induced by Clostridium difficile . Rev Infect Dis. 1979;1:370–378.CrossRefGoogle ScholarPubMed
4. Pierce, PF, Wilson, R, Silva, J, et al. Antibiotic-associated pseudomembranous colitis; an epidemiologic investigation of a cluster of cases. J Infect Dis. 1982;145:269–274.CrossRefGoogle ScholarPubMed
5. Gerding, DN, Olson, MM, Peterson, LR, et al. Clostridium difficile-associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study. Arch Intern Med. 1986;146:95–100.CrossRefGoogle ScholarPubMed
6. Wust, J, Sullivan, NM, Hardegger, V, Wilkins, TD. Investigation of an outbreak of antibiotic-associated colitis by various typing methods. J Clin Microbiol. 1982;16:1096–1101.CrossRefGoogle ScholarPubMed
7. Nolan, NPM, Kelly, CP, Humphreys, JFH, et al. An epidemic of pseudomembranous colitis: importance of person-to-person spread. Gut. 1987;28:1467–1473.CrossRefGoogle ScholarPubMed
8. Heard, SR, O'Farrell, S, Wolland, D, Crook, S, Barnett, MJ, Tabaqchah, S. The epidemiology of Clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis. 1986;153:159–162.CrossRefGoogle ScholarPubMed
9. Heard, SR, Wren, B, Barnett, MJ, Thomas, JM, Tabaqchah, S. Clostridium difficile infection in patients with haematological malignant disease: risk factors, faecal toxins and pathogenic strains. Epidemiol Infect. 1988;100:63–72.CrossRefGoogle ScholarPubMed
10. Larson, HE, Barclay, FE, Honow, P, Hill, ID. Epidemiology of Clostridium difficile in infants. J Infect Dis. 1982;146:727–733.CrossRefGoogle ScholarPubMed
11. McFarland, LV, Mulligan, M, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204–210.CrossRefGoogle ScholarPubMed
12. Viscidi, R, Willey, S, Bartlett, JG. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology. 1981;81:5–9.CrossRefGoogle ScholarPubMed
13. Fleiss, JL. Statistical Methods for Rates and Proportions. New York, NY: John Wiley and Sons; 1981.Google Scholar
14. Mantel, N, Fleiss, JL. Minimum expected cell size requirements for the Mantel-Haenszel one-degree of-freedom chi-square test and a related rapid procedure. Am J Epidemiol. 1980;112:129–134.CrossRefGoogle Scholar
15. Thomas, DG. Exact and asymptotic methods for the combination of 2×2 tables. Comput Biomed fles,1975;8:423–446.CrossRefGoogle Scholar
16. Rothman, KJ. Modern Epidemiology. Boston, Mass: Little Brown and Company; 1986.Google Scholar
17. Bartlett, JG. Antimicrobial agents implicated in Clostridium difficile toxin-associated diarrhea or colitis. Johns Hopkins Medical Journal. 1981;149:6–9.Google ScholarPubMed
18. Mulligan, ME, Rolfe, RD, Finegold, SM, George, WL. Contamination of a hospital environment by Clostridium dificile . Current Microbiology. 1979;3:173–175.CrossRefGoogle Scholar
19. Kim, KH, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981;143:42–50.CrossRefGoogle ScholarPubMed
20. Malamow-Ladas, H, O'Farrell, S, Nash, JQ, Tabaqchah, S. Isolation of Clostridium difficile from patients and the environment of hospital wards. J Clin Path. 1983;36:88–92.CrossRefGoogle Scholar
21. Garner, JS, Simmons, BP. CDC Guideline for isolation precautions in hospitals. Infect Control. 1983;4:245–325.Google ScholarPubMed
22. Bartlett, JG. Treatment of antibiotic-associated pseudomembranous colitis. Rev Infect Dis. 1984;6:S235–S241.CrossRefGoogle ScholarPubMed
23. Cherry, RD, Portnoy, D, Jabbari, M, Daly, DS, Kinnear, DG, Goresby, CA. Metronidazole: an alternate therapy for antibiotic-associated colitis. Gastroenterology. 1982;82:849–851.CrossRefGoogle ScholarPubMed
24. Tfeasley, DG, Gerding, DN, Olson, MM, et al. Prospective randomized trial of metronidazole versus vancomycin for Clostridium dificile-associated diarrhea and colitis. Lancet. 1983;1:1043–1046.CrossRefGoogle Scholar