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Risk factors for Clostridium difficile toxin-associated diarrhea
E Brown1, G H Talbot, P Axelrod
1Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia.
Infection Control and Hospital Epidemiology
|June 1, 1990
Summary
Clostridium difficile-associated diarrhea (CDAD) rates surged due to increased antibiotic use, particularly in older patients and those in intensive care. Control measures, including antibiotic restrictions, successfully reduced CDAD incidence.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Clostridium difficile-associated diarrhea (CDAD) incidence increased significantly at a tertiary-care university hospital.
- Rising CDAD rates correlated with changes in hospital antibiotic usage patterns.
Purpose of the Study:
- To investigate the epidemiology of a Clostridium difficile-associated diarrhea outbreak.
- To identify risk factors associated with CDAD and evaluate control measures.
Main Methods:
- Retrospective case-control study comparing CDAD patients with controls.
- Analysis of hospital antibiotic usage, patient demographics, and clinical factors.
- Logistic regression analysis to determine significant risk factors for CDAD.
Main Results:
- CDAD attack rates rose from 0.02% in 1982 to a peak of 2.25% in late 1987.
- Increased use of third-generation cephalosporins and intravenous vancomycin/metronidazole coincided with the rise.
- Significant risk factors included age >65, intensive care unit residence, gastrointestinal procedures, and prolonged antibiotic exposure (>10 days).
Conclusions:
- Antibiotic use, particularly certain classes and durations, is strongly linked to CDAD outbreaks.
- Implementation of control measures, including isolation, treatment, and antibiotic formulary restrictions, led to a significant decrease in CDAD rates.
- Targeted interventions are crucial for managing and preventing hospital-acquired Clostridium difficile infections.