title: Epidemic Clostridium difficile-associated diarrhea: role of second- and third-generation cephalosporins.
abstract: OBJECTIVE
  To better define the role of multiple risk factors for cytotoxic Clostridium difficile-associated diarrhea.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A Veterans Affairs Medical Center.
  
  
  METHODS
  Thirty-three case patients with C difficile-associated diarrhea. Two control groups were used: one group consisted of 32 patients from the same ward as the case patients, and one group consisted of 34 patients with nosocomial diarrhea and negative C difficile toxin assays.
  
  
  METHODS
  None.
  
  
  RESULTS
  Multivariate analyses revealed that exposure to second- or third-generation cephalosporins was the most important independent risk factor, even after controlling for other antimicrobial use (odds ratio [OR] = 8.3, 95% confidence interval [CI95] = 1.4 to 48.9 compared to ward controls; OR = 9.6, CI95 = 2.1 to 44.1 compared with diarrhea controls). Persons exposed to two or more antimicrobials simultaneously were at substantially elevated risk (OR = 18.7, CI95 = 4.1 to 85.8 compared with ward controls; OR = 21.5, CI95 = 3.2 to 141.9 compared with diarrhea controls).
  
  
  CONCLUSIONS
  Physicians should consider carefully the appropriateness of second- and third-generation cephalosporin use and combination antimicrobial therapy, especially during nosocomial C difficile-associated diarrhea outbreaks (Infect Control Hosp Epidemiol 1994;15:88-94).
authors.affiliation: Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: D E
authors.initials: DE
authors.lastname: Nelson
authors.forename: S B
authors.initials: SB
authors.lastname: Auerbach
authors.forename: A L
authors.initials: AL
authors.lastname: Baltch
authors.forename: E
authors.initials: E
authors.lastname: Desjardin
authors.forename: C
authors.initials: C
authors.lastname: Beck-Sague
authors.forename: C
authors.initials: C
authors.lastname: Rheal
authors.forename: R P
authors.initials: RP
authors.lastname: Smith
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects*; D016001:Confidence Intervals; D003428:Cross Infection / Q000139:chemically induced* / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D017053:Infection Control; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D002511:Cephalosporins