title: Clostridium difficile among hospitalized patients receiving antibiotics: a case-control study.
abstract: OBJECTIVE
  Clostridium difficile is the most common cause of infectious nosocomial diarrhea and can be found in up to 30% of asymptomatic hospitalized patients. Our primary aim was to compare the clinical characteristics of hospitalized patients who received antibiotics and developed C. difficile-associated diarrhea (CDAD) with those of hospitalized patients who received antibiotics and did not develop the disease.
  
  
  METHODS
  Case-control study comprising inpatients at a single institution.
  
  
  METHODS
  Case-patients were defined as patients who had diarrhea and tested positive for C. difficile. Control-patients (matched 4:1 to case-patients) were defined as patients who received antibiotics for at least 5 days and did not develop CDAD.
  
  
  RESULTS
  On univariate analysis, nine variables were associated with CDAD. Only three of the variables, need for intensive care, length of stay, and macrolide antibiotic use, were found to be significant (P < .05) on logistic regression analysis. The odds ratios for status as a CDAD case were 3.68 (CI95, 1.44 to 9.40) for stay in the intensive care unit and 1.03 (CI95, 1.02 to 1.05) for each day of hospital stay. Receipt of macrolide antibiotics reduced risk significantly; the odds ratio was 0.23 (CI95, 0.19 to 0.87).
  
  
  CONCLUSIONS
  We identified need for intensive care and length of stay as important risk factors for the development of CDAD. We also identified macrolide antibiotic use as protective against its development. Patients receiving intensive care may represent a population to study for targeted prophylaxis.
authors.affiliation: Gastroenterology Section, Temple University Hospital, 8 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Modena
authors.forename: Dilip
authors.initials: D
authors.lastname: Bearelly
authors.forename: Kenneth
authors.initials: K
authors.lastname: Swartz
authors.forename: Frank K
authors.initials: FK
authors.lastname: Friedenberg
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents