title: Clostridium difficile infection in an endemic setting in the Netherlands.
abstract: The purpose of this investigation was to study risk factors for Clostridium difficile infection (CDI) in an endemic setting. In a 34-month prospective case-control study, we compared the risk factors and clinical characteristics of all consecutively diagnosed hospitalised CDI patients (n = 93) with those of patients without diarrhoea (n = 76) and patients with non-CDI diarrhoea (n = 64). The incidence of CDI was 17.5 per 10,000 hospital admissions. C. difficile polymerase chain reaction (PCR) ribotype 014 was the most frequently found type (15.9%), followed by types 078 (12.7%) and 015 (7.9%). Independent risk factors for endemic CDI were the use of second-generation cephalosporins, previous hospital admission and previous stay at the intensive care unit (ICU). The use of third-generation cephalosporins was a risk factor for diarrhoea in general. We found no association of CDI with the use of fluoroquinolones or proton pump inhibitors (PPIs). The overall 30-day mortality among CDI patients, patients without diarrhoea and patients with non-CDI diarrhoea was 7.5%, 0% and 1.6%, respectively. In this endemic setting, risk factors for CDI differed from those in outbreak situations. Some risk factors that have been ascribed to CDI earlier were, in this study, not specific for CDI, but for diarrhoea in general. The 30-day mortality among CDI patients was relatively high.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: M P M
authors.initials: MP
authors.lastname: Hensgens
authors.forename: A
authors.initials: A
authors.lastname: Goorhuis
authors.forename: C M J
authors.initials: CM
authors.lastname: van Kinschot
authors.forename: M J T
authors.initials: MJ
authors.lastname: Crobach
authors.forename: C
authors.initials: C
authors.lastname: Harmanus
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D019353:Endemic Diseases; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins