title: Nosocomial diarrhea and Clostridium Difficile associated diarrhea in a Turkish University Hospital.
abstract: BACKGROUND
  Clostridium difficile (C. difficile) is a well-established cause of nosocomial diarrhea. The aim of our study was to define the incidence of nosocomial diarrhea in our hospital and to determine the role of C. difficile. Additionally, the risk factors for nosocomial diarrhea and Clostridium difficile associated diarrhea (CDAD) were investigated.
  
  
  METHODS
  We included all patients, 18 years of age or more, who were admitted to the Uludag Teaching Hospital between October 1, 2004 and February 1, 2005, and developed diarrhea at least three days after hospital admission. A case-control study was performed.
  
  
  RESULTS
  The total incidence of nosocomial diarrhea was 0.6 per 1,000 hospitalization-days and 5 per 1,000 patients' admissions. Previous use of chemotherapy was found to be an important predisposing factor for nosocomial diarrhea. The incidence of CDAD was 0.26 per 1,000 hospitalization-days and 2.1 per 1,000 admissions, comparable with incidence rates in Europe. CDAD was diagnosed in 43% of patients with nosocomial diarrhea. No severe cases of CDAD were diagnosed. A correlation was found between CDAD and antibiotic use before admission and during admission in univariate analysis. PCR ribotyping revealed four strains of PCR ribotype 002 and 1 strain of ribotype 012 out of 5C. difficile strains available for extensive identification.
  
  
  CONCLUSIONS
  The incidence rates of nosocomial diarrhea and CDAD are not different than the usual incidence rates in Europe. C. difficile was the causative agent in 43% of patients with nosocomial diarrhea.
authors.affiliation: Uludağ University, Medical School Department of Infectious Diseases and Microbiology, Bursa, Turkey.
authors.forename: E K
authors.initials: EK
authors.lastname: Ergen
authors.forename: H
authors.initials: H
authors.lastname: Akalin
authors.forename: E
authors.initials: E
authors.lastname: Yilmaz
authors.forename: M
authors.initials: M
authors.lastname: Sinirtaş
authors.forename: O
authors.initials: O
authors.lastname: Alver
authors.forename: Y
authors.initials: Y
authors.lastname: Heper
authors.forename: C
authors.initials: C
authors.lastname: Ozakin
authors.forename: D
authors.initials: D
authors.lastname: Bakker
authors.forename: B
authors.initials: B
authors.lastname: Ener
authors.forename: R
authors.initials: R
authors.lastname: Mistik
authors.forename: S
authors.initials: S
authors.lastname: Helvaci
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology*; D017931:DNA Primers; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000635:transmission; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D017931:DNA Primers