title: Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital.
abstract: A prospective survey of the adult inpatient population of an urban tertiary care hospital was conducted to determine factors associated with the development of nosocomial diarrhea and the acquisition of Clostridium difficile-associated disease. During the 3-month survey, 98 patients with nosocomial diarrhea were enrolled, and 38 controls were recruited. The controls were patients without diarrhea lying in beds adjacent to the affected patients. Factors significantly associated with nosocomial diarrhea were the administration of a special diet (P=0.02) and receipt of a greater number of different antibiotics (P=0.02). Among the 98 patients with diarrhea, Clostridium difficile toxin B was identified in the stool of 13. Factors found to be associated with the presence of toxin B as compared to other causes of nosocomial diarrhea were a greater number of individual antibiotics used during hospitalization (P=0.02) and receipt of a cephalosporin (P=0.03) or, more specifically, a third-generation cephalosporin (P=0.02). Among patients with nosocomial diarrhea, those who had toxin in their stool had a significantly higher total antibiotic burden (expressed as antibiotic days) than those with diarrhea due to other causes (P=0.01).
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: A
authors.initials: A
authors.lastname: Simhon
authors.forename: C
authors.initials: C
authors.lastname: Block
authors.forename: V
authors.initials: V
authors.lastname: Roval
authors.forename: N
authors.initials: N
authors.lastname: Ferderber
authors.forename: M
authors.initials: M
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000032:analysis; D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification* / Q000378:metabolism; D003015:Clostridium Infections / Q000209:etiology*; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology*; D003967:Diarrhea / Q000209:etiology* / Q000382:microbiology*; D004750:Enteral Nutrition / Q000009:adverse effects; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology* / Q000382:microbiology; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D005527:Food, Fortified / Q000009:adverse effects; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D002511:Cephalosporins; C031815:toxB protein, Clostridium difficile