Risk Factors for Clostridium difficile Toxin-Associated Diarrhea

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%.

Predictors of Clostridium difficile colitis infections in hospitals

“…Hospitals with slower bed turnover rates and therefore increased CDAD rates may potentially have increased comorbidity or patient severity of illness. Others have described similar associations when comparing patient-level risk factors for CDAD [11][12][13].…”

“…A number of authors have sought to define patientlevel risk factors that predispose patients to CDAD. Most such analyses have examined patient demographics [7][8][9], comorbid conditions [10][11][12], clinical variables [7,8], and antibiotic treatment characteristics [7,8,13]. Patient-level risk factors have been used to help develop treatment algorithms [14], and may also be useful in developing prevention and control measures.…”

Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma

“…2,6 Increasing age has been a consistently noted risk factor, with more than tenfold increased risk for patients older than 60 years of age. 11,12 Second, our study only included patients with lymphoma and multiple myeloma in contrast to the other two studies, which included patients with other diagnoses. 2,6 More than half of the patients in the study by Bilgrami et al 6 had solid tumors, while the study by Tomblyn et al 2 included patients with other hematologic malignancies.…”

Alternative treatments for Clostridium difficile disease: what really works?

“…Several studies have shown that restriction of clindamycin use was associated with a reduction in nosocomial CDAD cases (Brown et al, 1990;Pear et al, 1994). Other hospitals' rates of CDAD decreased, by at least 50 %, after restricting cephalosporin use (Ludlam et al, 1999;Khan & Cheesbrough, 2003).…”