Prevalence and clinical features of Clostridium difficile-associated diarrhea in a tertiary hospital in northern Taiwan.
OBJECTIVE
Although the clinical manifestations of and risk factors for Clostridium difficile-associated diarrhea (CDAD) have been extensively investigated in western populations, data from Taiwanese patients are comparatively limited. This study investigated the incidence density of CDAD in Taiwanese patients and also the risk factors and clinical manifestations of CDAD.


METHODS
From September 21, 2003 to December 21, 2003, patients hospitalized in 2 infection wards and 6 medical intensive care units at National Taiwan University Hospital who were older than 20 years, had a history of antibiotic usage within the prior 6 weeks, and developed diarrhea without another identified etiology were classified as having antibiotic-associated diarrhea (AAD), and were enrolled for further study. The diagnosis of CDAD was established when toxin A of C. difficile was detected in stool.


RESULTS
The incidence density of AAD was 1/100 person-days of antibiotics usage. CDAD accounted for 12.5% of AAD. Fever and abdominal discomfort developed in only less than half of CDAD patients. Pus cell in the stool sample was found in 100 percent of patients with CDAD. Univariate analysis revealed that presence of malignancy and treatment with antifungal agents within the previous 6 weeks were risk factors for CDAD development. In multivariate analysis, use of antifungal agents was the only independent risk factor for CDAD.


CONCLUSIONS
The incidence density of CDAD in this study of Taiwanese patients with AAD was 12.5%. Prior usage of antifungal agents was the only independent factor associated with subsequent CDAD development in patients with AAD.
Hsu
Meng Shiuan
MS
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wang
Jann Tay
JT
Huang
Wen Kuei
WK
Liu
Yung Ching
YC
Chang
Shan Chwen
SC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000935:Antifungal Agents / Q000009:adverse effects; D001426:Bacterial Proteins / Q000302:isolation & purification; D001427:Bacterial Toxins / Q000302:isolation & purification; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003967:Diarrhea / Q000139:chemically induced* / Q000453:epidemiology / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology; D004768:Enterotoxins / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile