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Risk Factors for Clostridium difficile Cytotoxin-Positive Diarrhea After Control for Horizontal Transmission

Published online by Cambridge University Press:  21 June 2016

Richard Kent Zimmerman
Richard Kent Zimmerman*
Affiliation:
Department of Family Practice, University of Minnesota, Minneapolis, Minnesota
*
Department of Family Practice, Box 381 UMHC, 516 Delaware St., SE, Minneapolis, MN 55455
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Abstract

Objective:

This study identifies risk factors that predispose hospitalized patients to diarrhea caused by Clostridium difficile.

Design:

Unlike most previous studies, this case-control study accounts for horizontal (person-to-person) transmission of this infectious organism by matching on location.

Setting:

An urban community hospital of 600 beds with both primary care and referred patients.

Patients:

Both the 36 cases and the 36 controls came from billing printouts for C difficile cytotoxin assays. Exclusion criteria included outpatient specimens and stays of 38 days or more. Controls had negative assays and were individually matched on the basis of the floor and by the general date of specimen collection.

Results:

Cases had a longer mean duration of antibiotic use (6.7 versus 4.1 days, p = .006). Of the other 22 factors that were evaluated for their risk of predisposing to C difficile, only clindamycin (OR = 3.50, p =.09) and third-generation cephalosporins (OR = 3.00, p = .04) showed any association. The odds ratio for third-generation cephalosporins in the absence of clindamycin was 3.50 (p = .09). Data were collected by physicians who were not blinded.

Conclusions:

This study found that the clindamycin and third-generation cephalosporins were risk factors for C difficile-associated diarrhea after controlling for horizontal transmission. First-generation cephalosporins were not risk factors (OR= 0.86), while sample size considerations prevented firm conclusions about second-generation cephalosporins (OR = 1.67, p = .23). Many of the previously alleged risk factors might be explained by the horizontal transmission of an infectious disease; for instance, this seems a better explanation for an outbreak on a surgery ward than does surgery itself. (Infect Control Hosp Epidemiol. 1991;12:96-100.)

Type
Brief Report
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 2 , February 1991 , pp. 96 - 100
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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