title: Risk factors for Clostridium difficile-associated diarrhea on an adult hematology-oncology ward.
abstract: Nosocomial diarrhea caused by Clostridium difficile causes significant morbidity and mortality in an increasing proportion of hospitalized patients annually. This case-control study of patients admitted to the hematology-oncology ward of a tertiary academic medical center over a 2-year period demonstrates that patients with Clostridium difficile-associated diarrhea (CDAD) were 22 times more likely than ward-matched controls with diarrhea to have received any antibiotic either during hospitalization or in the month preceding admission (p < 0.005), and they were nearly three times as likely as controls to have received a cephalosporin during the same period (p < 0.005). Diarrhea among lung cancer patients was approximately three times more likely to be caused by this organism than to be due to other causes (p = 0.04). A trend towards CDAD patients receiving higher numbers of different antibiotics during hospitalization (3.3 vs. 2.6, 95%CI -1.42-0.02, p = 0.06) was noted. Administration of interleukin-2 either during hospitalization or in the 30 days preceding admission was seven times more likely to have occurred in CDAD cases (p = 0.04), raising the question of whether or not this agent increases risk.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. giffora@hitchcock.org
authors.forename: A H
authors.initials: AH
authors.lastname: Gifford
authors.forename: K B
authors.initials: KB
authors.lastname: Kirkland
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001427:Bacterial Toxins / Q000302:isolation & purification*; D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000472:pathogenicity; D003015:Clostridium Infections / Q000209:etiology*; D003428:Cross Infection / Q000382:microbiology*; D003967:Diarrhea / Q000209:etiology / Q000382:microbiology*; D064420:Drug-Related Side Effects and Adverse Reactions; D004768:Enterotoxins / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D002511:Cephalosporins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile