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Difference in the Incidence of Clostridium difficile Among Patients Infected With Human Immunodeficiency Virus Admitted to a Public Hospital and a Private Hospital

Published online by Cambridge University Press:  02 January 2015

Joseph J. Pulvirenti ,
Dale N. Gerding ,
Catherine Nathan ,
Irfan Hafiz ,
Tarun Mehra ,
Dayle Marsh ,
Frank Kocka ,
Thomas Rice ,
Staci A. Fischer  and
John Segreti
...Show all authors
Joseph J. Pulvirenti*
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Dale N. Gerding
Affiliation:
VA Chicago Health Care System, Lakeside Division, and the Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
Catherine Nathan
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Irfan Hafiz
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Tarun Mehra
Affiliation:
Lyndon Medical Center, Columbus, Ohio
Dayle Marsh
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Frank Kocka
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Thomas Rice
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Staci A. Fischer
Affiliation:
Rush Presbyterian St. Luke's Medical Center, Rush Medical College, Chicago, Illinois
John Segreti
Affiliation:
Rush Presbyterian St. Luke's Medical Center, Rush Medical College, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
*
Division of Infectious Diseases, Cook County Hospital, 1835 West Harrison, Chicago, IL 60612
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Abstract

Objective:

To compare the occurrence of Clostridium difficile among inpatients infected with human immunodeficiency virus (HPV) in two different hospitals.

Design:

Prospective, observational study.

Setting:

Specialized HPV inpatient units.

Patients:

HIV-infected inpatients at Cook County Hospital (CCH) and Rush Presbyterian St. Luke's Medical Center (RPSLMC).

Interventions:

A clinical and epidemiologic assessment of patient risk factors for C. difficile was performed. C. difficile isolates found on stool, rectal, and environmental cultures were typed by pulsed-field gel electrophoresis.

Results:

Twenty-seven percent of patients admitted to CCH versus 4% of patients admitted to RPSLMC had positive cultures for C. difficile (P = .001). At CCH, 14.7% of environmental cultures were positive versus 2.9% at RPSLMC (P = .002). Risk factors for C. difficile acquisition included hospitalization at CCH, more severe HrV, use of acyclovir and H2-blockers, and longer hospital stay. Patients admitted to CCH were taking more antibiotics, had longer hospital stays, and more frequently had a history of C. difficile infection. During the study, two strains (CD1A and CD4) extensively contaminated the CCH environment. However, only CD1A caused an outbreak.

Conclusions:

The C. difficile acquisition rate at CCH was sevenfold higher than that at RPSLMC, and CCH had a more contaminated environment Differences in patient acquisition rates likely reflect a greater prevalence of traditional C. difficile risk factors and a concurrent outbreak at CCH. Although two strains heavily contaminated the environment at CCH, only one caused an outbreak, suggesting that factors other than the environment are important in initiating C. difficile outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 641 - 647
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996; 100:32–40.CrossRefGoogle ScholarPubMed
2.Olson, MM, Shanholtzer, CJ, Lee, JT Jr, Gerding, DN. CDAD rates: reply. Infect Control Hosp Epidemiol 1995;16:64–65.Google Scholar
3.Climo, MW, Israel, DS, Wong, ES, Williams, D, Coudron, P, Markowitz, SM. Hospital wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989–995.Google Scholar
4.Pear, S, Williamson, T, Bettin, K, Gerding, DN, Galgiani, JN. Decrease in nosocomial Clostridium difficile-assodated diarrhea by restricting clindamycin use. Ann Intern Med 1994;120:272–277.Google Scholar
5.Johnson, S, Gerding, DN, Olson, MM, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137–140.Google Scholar
6.Cartmill, TDI, Panigrahi, H, Worsley, MA, McCann, DC, Nice, CN, Keith, E. Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J Hosp Infect 1994;27:1–15.Google Scholar
7.Brooks, SE, Veal, RO, Kramer, M, Dore, L, Schupf, N, Adachi, M. Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single use disposables. Infect Control Hosp Epidemiol 1992;13:98–103.Google Scholar
8.Fischer, S, Pulvirenti, J, Lisowski, J, et al. Clostridium difficile associated diarrhea (CDAD) in HIV positive (HIV+) patients. Presented at the 93rd General Meeting of the American Society of Microbiology; May 23-27, 1994; Las Vegas, NV. Abstract.Google Scholar
9.Chundi, V, Pulvirenti, J, Gerding, D, et al. Incidence of Clostridium difficile diarrhea (CDD) in human immunodeficiency virus (HIV) infection. Presented at the 35th Annual Meeting of the Infectious Diseases Society of America; September 17-20,1995; San Francisco, CA Abstract.Google Scholar
10.Mocroft, A, Johnson, M, Sabin, C, Lipman, M. Staging system for clinical AIDS patients. Lancet 1995;346:12–17.Google Scholar
11.Wilson, KH, Kennedy, MJ, Fekety, FR. Use of sodium taurocholate to enhance recovery on a medium selective for Clostridium difficile. J Clin Microbiol 1982;15:443–446.Google Scholar
12.Matushek, MG, Bonten, MJM, Hayden, MK. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol 1996;34:2598–2600.Google Scholar
13.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
14.Pulvirenti, J, Mehra, T, Hafiz, I, et al. Epidemiology and outcome of Clostridium difficile infection and diarrhea in HIV infected patients. Diagn Microbiol Infect Dis. In press.Google Scholar
15.Barbut, F, Meynard, JL, Guiguet, M, et al. Clostridium difficile associated diarrhea in HIV infected patients: epidemiology and risk factors. J Acquir Immune Defic Syndr 1997;16:176–181.Google Scholar
16.Tumbarello, M, Tacconelli, E, Leone, F, Cauda, R, Ortona, L. Clostridium difficile-associated diarrhea in patients with human immunodeficiency virus infection: a case control study. Eur J Gastroenterol Hepatol 1995; 7:259–263.Google Scholar
17.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
18.Brown, E, Talbot, GH, Axelrod, P, Provencher, M, Hoegg, C. Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol 1990;11:283–290.Google Scholar
19.Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992; 166:561–567.Google Scholar
20.McFarland, LV, Surawicz, CM, Stamm, WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678–684.Google Scholar
21.Reinke, CM, Messick, CR. Update on Clostridium difficile-induced colitis, part 1. American Journal of Hospital Pharmacology 1994;51:1771–1781.Google ScholarPubMed
22.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
23.Barbut, F, Mario, N, Meyohas, MC, Binet, D, Frottier, J, Petit, JC. Investigation of a nosocomial outbreak of Clostridium difficile-associated diarrhea among AIDS patients by random amplified polymorphic DNA (RAPD) assay. J Hosp Infect 1994;26:181–189.Google Scholar
24.Johnson, S, Clabots, CR, Linn, FV, Olson, MM, Peterson, LR, Gerding, DN. Nosocomial Clostridium difficile colonisation and disease. Lancet 1990;336:97–100.Google Scholar
25.Samore, MH, DeGirolami, PC, Tlucko, A, Lictenberg, DA, Melvin, ZA, Karchmer, AW. Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clin Infect Dis 1994;18:181–187.Google Scholar
26.Karlstrom, O, Fryklund, B, Tullus, K, Burman, L. A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 1998;26:141–145.Google Scholar
27.Johnson, S, Samore, MH, Farrow, KA, et al. Epidemics of diarrhea caused by clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341:1645–1651.CrossRefGoogle ScholarPubMed
28.Borriello, SP, Ketley, JM, Mitchell, TJ. Clostridium difficile: a spectrum of virulence and analysis of putative virulence determinants in the hamster model of antibiotic-associated colitis. J Med Microbiol 1987;24:53–64.Google Scholar