Epidemic Clostridium difficile-associated diarrhea: role of second- and third-generation cephalosporins.
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).
Nelson
D E
DE
Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA.
Auerbach
S B
SB
Baltch
A L
AL
Desjardin
E
E
Beck-Sague
C
C
Rheal
C
C
Smith
R P
RP
Jarvis
W R
WR
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
D002511:Cephalosporins