Risk factors for acquisition of Clostridium difficile-associated diarrhea among outpatients at a cancer hospital.
BACKGROUND
Clostridium difficile-associated diarrhea (CDAD) is an important infection in hospital settings. Its impact on outpatient care has not been well defined.


OBJECTIVE
To examine risk factors of ambulatory cancer patients with CDAD.


METHODS
Case-control study.


METHODS
Memorial Sloan-Kettering Cancer Center, a tertiary-care hospital.


METHODS
Cases of CDAD among oncology outpatients from January 1999 through December 2000 were'identified via positive C. difficile toxin assay results on stool specimens sent from clinics or the emergency department. A 1:3 matched case-control study examined exposures associated with CDAD.


RESULTS
Forty-eight episodes of CDAD were identified in cancer outpatients. The mean age was 51 years; 44% were female. Forty-one (85%) had received antibiotics within 60 days of diagnosis, completing courses a median of 16.5 days prior to diagnosis. Case-patients received longer courses of first-generation cephalosporins (4.8 vs 3.2 days; P = .03) and fluoroquinolones (23.6 vs 8 days; P < .01) than did control-patients. Those receiving clindamycin were 3.9-fold more likely to develop CDAD (P < .01). For each additional day of clindamycin or third-generation cephalosporin exposure, patients were 1.29- and 1.26-fold more likely to develop CDAD (P < .01 and .04, respectively). The 38 CDAD patients hospitalized during the risk period (79.2%) spent more time as inpatients than did control-patients (19.3 vs 9.7 days; P < .001).


CONCLUSIONS
Antibiotic use, especially with cephalosporins and clindamycin, and prolonged hospitalization contributed to the development of CDAD. Outpatient CDAD appears to be most strongly related to inpatient exposures; reasons for the delayed development of symptoms are unknown.
Palmore
Tara N
TN
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Sohn
SeJean
S
Malak
Sharp F
SF
Eagan
Janet
J
Sepkowitz
Kent A
KA
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002173:Cancer Care Facilities; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000472:pathogenicity*; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010045:Outpatients; D012307:Risk Factors
D000900:Anti-Bacterial Agents