Risk factors for Clostridium difficile colonisation and toxin production.
OBJECTIVE
to examine risk factors for patients becoming Clostridium difficile culture and toxin positive.


METHODS
prospective cohort study.


METHODS
two medicine for the elderly wards.


METHODS
patients admitted to the wards over a 17-month period.


METHODS
presence of Clostridium difficile on culture of stool specimens and toxins A and/or B. Patient's age, sex, source of admission, antibiotic, laxative, antacid and steroid use, presence/absence of colonic disease, neoplasia, leukaemia and nasogastric or percutaneous endoscopic gastrostomy tube feeding.


RESULTS
390 of 865 patients admitted provided a total of 1003 faecal specimens. Age (OR 1.04, 95% CI 1.001-1.07 per year), admission from another hospital (OR 2.13, 95% CI 1.29-3.50), non-cephalosporin antibiotics (OR 2.08, 95% CI 1.25-3.46) and cephalosporin use (OR 8.45, 95% CI 2.99-23.9) increased risk of becoming Clostridium difficile culture positive. Becoming toxin-positive was associated with antibiotic use only (OR 3.02, 95% CI 1.15-7.92), specifically amoxycillin (OR 8.72, 95% CI 1.66-45.9) and cephalosporins other than ceftriaxone (OR 7.28, 95% CI 1.34-39.6).


CONCLUSIONS
different risk factors are important for the two stages leading to Clostridium difficile diarrhoea. Age, source of admission and third generation cephalosporins increase risk of becoming culture positive, whilst only antibiotic use is associated with the step of becoming toxin-positive. Understanding these differential risks may aid infection control strategies.
Geriatric Medicine Unit, Edinburgh University, Royal Victoria Hospital, Craigleith Road, Edinburgh EH4 2DN, UK. John.Starr@ed.ac.uk
John M
JM
Starr
Heather
H
Martin
Jodie
J
McCoubrey
Gavin
G
Gibson
Ian R
IR
Poxton
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000032:analysis*; D001431:Bacteriological Techniques; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D016360:Clostridioides difficile; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004768:Enterotoxins / Q000032:analysis*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D002511:Cephalosporins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile