title: Clostridium difficile infection in general surgery patients; identification of high-risk populations.
abstract: BACKGROUND
  Risk factors associated with Clostridium difficile infection (CDI) in general surgical patients are poorly characterised. This study aimed to characterise the incidence and associations of C. difficile positivity (CDP) in general surgical inpatients to aid in the design of future policies regarding focused screening and risk-stratification mechanisms in this patient subpopulation.
  
  
  METHODS
  Discharge, laboratory and coding data from all general surgery inpatients admitted to a large tertiary referral general surgical unit, between March 2005 and May 2007, were examined.
  
  
  RESULTS
  21,371 patient records were interrogated. 101 (0.47%) CDP cases were identified from laboratory records and compared with non-CDP controls for age, gender, length of stay (LOS), admission to intensive care unit or high dependency unit (ICU/HDU), co-morbidities and surgical procedures. Univariate analysis identified a range of risk factors associated with positivity. Multivariate analysis identified malignancy, gastrointestinal disease, anaemia, respiratory disease, circulatory disease, diabetes mellitus, those undergoing gastrointestinal surgery and increasing age to be independently associated with CDP status.
  
  
  CONCLUSIONS
  This study identifies incidence and risk factor associations of those who tested CDP in a large contemporary general surgery inpatient population. Focused screening programmes based on high-risk populations may provide information on further risk factors and allow risk-stratification. Further healthcare worker education regarding risk factors may reduce the clinical impact of CDI by encouraging increased vigilance and therefore earlier detection.
authors.affiliation: Department of General Medicine, Western General Hospital, Edinburgh, Scotland, United Kingdom. mark.a.rodrigues@gmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: Rodrigues
authors.forename: R R
authors.initials: RR
authors.lastname: Brady
authors.forename: J
authors.initials: J
authors.lastname: Rodrigues
authors.forename: C
authors.initials: C
authors.lastname: Graham
authors.forename: A P
authors.initials: AP
authors.lastname: Gibb
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013531:Surgicenters / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology