title: Epidemiology of Clostridium difficile-associated diarrhea in a Peruvian tertiary care hospital.
abstract: The prevalence, incidence, and epidemiologic factors of Clostridium difficile-associated diarrhea (CDAD) in a Peruvian hospital were studied. We conducted a cross-sectional study in patients > 14 years of age from medical/surgical wards of the Cayetano Heredia National Hospital (Lima, Peru) from September 2005 to May 2006. CDAD was defined in a case of nosocomial diarrhea when C. difficile toxin A and/or toxin B was detected by enzyme immune assay (EIA) in stools. A total of 4,264 patients were admitted, with 156 (3.7%) developing nosocomial diarrhea. Fifty-five of 156 (35.2%) cases of nosocomial diarrhea were diagnosed as CDAD. The overall incidence per 1,000 admissions was 12.9. Multivariate analysis showed that use of diapers (OR, 3.54; 95% CI, 1.71-7.34; P = 0.001) and presence of another patient with CDAD housed in the same room (OR, 2.97; 95% CI, 1.14-7.76; P = 0.026) were significantly associated with CDAD. Hospital transmission of C. difficile commonly occurred, supporting infection-appropriate measures directed toward the reduction of CDAD in low-resource settings.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú. 03345@upch.edu.pe
authors.forename: Coralith
authors.initials: C
authors.lastname: Garcia
authors.forename: Frine
authors.initials: F
authors.lastname: Samalvides
authors.forename: Margot
authors.initials: M
authors.lastname: Vidal
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: Herbert L
authors.initials: HL
authors.lastname: Dupont
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection; D003430:Cross-Sectional Studies; D003906:Developing Countries; D041382:Diapers, Adult; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010568:Peru / Q000453:epidemiology; D012307:Risk Factors