title: Epidemiology of suspected Clostridium difficile-associated hospital-acquired diarrhea in hospitalized patients at Siriraj Hospital.
abstract: BACKGROUND
  Clostridium difficile-associated disease (CDAD) is an important cause of hospital-acquired diarrhea.
  
  
  OBJECTIVE
  To determine the prevalence, risk factors, diagnosis, treatments and outcomes of the patients with CDAD in hospitalized patients at Siriraj Hospital.
  
  
  METHODS
  The medical records of hospitalized patients aged older than 14 years who developed hospital-acquired diarrhea and their stool samples were sent for detection of C. difficile toxins from March to June 2008 were reviewed. Risk factors of CDAD were identified by reviewing medical records of CDAD patients (case group) and patients who had hospital-acquired diarrhea without C. difficile toxins (control group). The patients in the control group were matched with the case group in terms of gender and age.
  
  
  RESULTS
  Three hundred and twenty three stool samples obtained from 255 adult hospitalized patients were sent to microbiology laboratory for detection of C. difficile toxins. The prevalence of CDAD in suspected C. difficile-associated hospital-acquired diarrhea was 12.3% (95% CI 8.5% to 17.6%). Univariate analysis showed that antibiotic use (> or =2 agents), proton pump inhibitor (PPI) use, hematologic malignancy, receiving chemotherapy or immunosuppressive agents were associated with CDAD. Multivariate analysis revealed that only antibiotic use (> or =2 agents), PPI use and hematologic malignancy were independent risk factors associated with CDAD. Nasogastric intubation was observed to be associated with CDAD as a protective factor from both univariate and multivariate analyses. Diagnosis of CDAD in most of the patients was made by a presence of C. difficile toxin in their stool samples. Response rate to metronidazole was 74.5%. The recurrence rate of CDAD was 3.2%. The mortality rate due to CDAD was 3.2%.
  
  
  CONCLUSIONS
  CDAD is not uncommon in the patients with hospital-acquired diarrhea especially in those who have hematologic malignancy, receive multiple antibiotics or receive PPI. Metronidazole is an acceptable treatment for CDAD. The recurrence rate of CDAD and mortality rate due to CDAD are low.
authors: Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Wilawan
authors: W
authors: Thipmontree
authors: Pattarachai
authors: P
authors: Kiratisin
authors: Sathaporn
authors: S
authors: Manatsathit
authors: Visanu
authors: V
authors: Thamlikitkul
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents