title: Quinolone use as a risk factor for nosocomial Clostridium difficile-associated diarrhea.
abstract: OBJECTIVE
  To determine modifiable risk factors for nosocomial Clostridium difficile-associated diarrhea (CDAD).
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  300-bed tertiary-care hospital.
  
  
  METHODS
  Hospital inpatients present during the 3-month study period.
  
  
  METHODS
  Case-patients identified with nosocomial CDAD over the study period were compared to two sets of control patients: inpatients matched by age, gender, and date of admission; and inpatients matched by duration of hospital stay. Variables including demographic data, comorbid illnesses, antibiotic exposure, and use of gastrointestinal medications were assessed for case- and control-patients. Conditional logistic regression was performed to identify risk factors for nosocomial CDAD.
  
  
  RESULTS
  27 case-patients were identified and were compared to the two sets of controls (1:1 match for each comparison set). For the first set of controls, use of ciprofloxacin (odds ratio [OR], 5.5; 95% confidence interval [CI 95], 1.2-24.8; P=.03) was the only variable that remained significant in the multivariable model. For the second set of controls, prior exposure to cephalosporins (OR, 6.7; CI 95, 1.3-33.7; P=.02) and to ciprofloxacin (OR, 9.5; CI 95, 1.01-88.4; P=.05) were kept in the final model.
  
  
  CONCLUSIONS
  Along with cephalosporins, prior quinolone use predisposed hospitalized patients to nosocomial CDAD. Quinolones should be used judiciously in acute-care hospitals, particularly in those where CDAD is endemic.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Yip
authors.forename: M
authors.initials: M
authors.lastname: Loeb
authors.forename: S
authors.initials: S
authors.lastname: Salama
authors.forename: L
authors.initials: L
authors.lastname: Moss
authors.forename: J
authors.initials: J
authors.lastname: Olde
mesh_terms: D042462:4-Quinolones; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D042462:4-Quinolones; D000890:Anti-Infective Agents