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Specific risk factors for Clostridium difficile-associated diarrhea: a prospective, multicenter, case control
Kimi S Vesta1, Paula G Wells, Chris A Gentry
1University of Oklahoma College of Pharmacy, Oklahoma City, OK 73190-5040, USA. Kimi.Vesta@ouhsc.edu
American Journal of Infection Control
|October 12, 2005
Summary
Clostridium difficile-associated diarrhea (CDAD) was not linked to antibiotic use in this study. Patient illness severity, not antibiotic exposure, differentiated cases from controls, suggesting other causes for diarrhea in hospitalized patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Clinical Microbiology
Background:
- Clostridium difficile is a toxin-producing bacterium causing colonic mucosal damage.
- C difficile-associated diarrhea (CDAD) results from disruption of normal gut flora, allowing C difficile proliferation.
- CDAD can lead to severe complications including intestinal dilation and perforation.
Purpose of the Study:
- To assess and quantify risk factors for Clostridium difficile-associated diarrhea (CDAD).
- To specifically investigate the association between antibiotic use and CDAD development.
- To identify independent risk factors for CDAD in hospitalized patients.
Main Methods:
- A multicenter, prospective observational case-control study design was employed.
- Hospitalized patients with diarrhea requiring C difficile toxin testing were included.
- Cases were matched with controls (negative toxin test) by age, sex, length of stay, and institution.
Main Results:
- No significant differences in antibiotic use were observed between CDAD cases and controls.
- Patient severity, assessed by Horn's Index, was significantly higher in cases (P = .0022).
- No other significant variables were identified as independent risk factors.
Conclusions:
- Higher illness severity, not antibiotic use, distinguished CDAD cases from controls.
- Negative C difficile tests in controls suggest alternative etiologies for diarrhea, potentially antibiotic-associated diarrhea, despite similar antibiotic exposure.
- Further research is needed to elucidate the multifactorial nature of diarrhea in hospitalized patients.