title: Specific risk factors for Clostridium difficile-associated diarrhea: a prospective, multicenter, case control evaluation.
abstract: BACKGROUND
  Clostridium difficile is a toxin-producing bacterium that is responsible for toxicity to the colonic mucosa, causing inflammation, necrosis, and, in some extreme cases, intestinal dilation and perforation. C difficile-associated diarrhea (CDAD) occurs when patients have a reduction in their natural gastrointestinal flora that allows for the proliferation of and toxin production by C difficile.
  
  
  METHODS
  Using a multicenter, prospective observational case control study, we assessed and quantified risk factors associated with the development of diarrhea caused by Clostridium difficile, with particular attention to antibiotic use. All hospitalized patients with diarrhea requiring a C difficile toxin test as part of their routine clinical workup were considered for study inclusion. Patients with a negative specimen (controls) were considered for enrollment if matched (by age, sex, length of stay, and institution) to a case. Variables associated with CDAD were identified using univariate analysis. Significant factors were then entered into multivariate logistic regression analysis to identify independent factors.
  
  
  RESULTS
  There were no significant differences in antibiotic use between cases and controls. Patient severity, classified by Horn's Index, was significantly different between cases and controls (P = .0022). No other significant variables were identified.
  
  
  CONCLUSIONS
  The severity of illness of the cases was classified as more severe than the controls, but no significant differences in antibiotic use were identified between the groups. The negative C difficile toxin studies on the well-matched control patients indicate a different etiology of diarrhea (such as antibiotic-associated diarrhea), which may have developed in the presence of similar antibiotic use as the cases.
authors.affiliation: University of Oklahoma College of Pharmacy, Oklahoma City, OK 73190-5040, USA. Kimi.Vesta@ouhsc.edu
authors.forename: Kimi S
authors.initials: KS
authors.lastname: Vesta
authors.forename: Paula G
authors.initials: PG
authors.lastname: Wells
authors.forename: Chris A
authors.initials: CA
authors.lastname: Gentry
authors.forename: Wanda J
authors.initials: WJ
authors.lastname: Stipek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001427:Bacterial Toxins / Q000032:analysis; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D003967:Diarrhea / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins