Risk factors for Clostridium difficile-associated diarrhea among hospitalized adults with fecal toxigenic C. difficile colonization.
BACKGROUND
Patients with toxigenic Clostridium difficile colonization (tCDC) are at risk of developing C. difficile-associated diarrhea (CDAD). However, the risk factors of hospitalized patients with tCDC developing CDAD are not clear.


METHODS
We conducted an 18-month prospective study at a medical ward in a district hospital in southern Taiwan. Within 48 hours of admission, weekly stool samples from asymptomatic hospitalized patients were obtained to detect fecal CDC. A polymerase chain reaction for tcdB was performed to determine toxigenic isolates. CDAD was diagnosed if the patient had diarrhea and toxigenic C. difficile present in a stool sample.


RESULTS
A total 483 patients with stool samples were eligible for the study. Eighty-six (17.8%) patients had tCDC after screening, of whom 14 (16.3%) developed CDAD during follow-up. Among those with tCDC, patients with subsequent CDAD were more likely to have diabetes mellitus (p = 0.01) and to have received piperacillin-tazobactam (p = 0.04), or proton-pump inhibitors (PPIs; p = 0.04) than those without developing CDAD. The variables were statistically significant as determined by multivariate analysis. However, the 60-day crude mortality rates among tCDC patients with and without subsequent development of CDAD were similar.


CONCLUSIONS
Diabetes mellitus and recent receipt of piperacillin-tazobactam or PPIs are independent risk factors for the development of CDAD among hospitalized patients with tCDC.
Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
Hsiao-Ju
HJ
Lin
Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan.
Yuan-Pin
YP
Hung
Department of Experiment and Diagnosis, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
Hsiu-Chuan
HC
Liu
Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
Jen-Chieh
JC
Lee
Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
Chih-I
CI
Lee
Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
Yi-Hui
YH
Wu
Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: peijtsai@mail.ncku.edu.com.
Pei-Jane
PJ
Tsai
Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
Wen-Chien
WC
Ko
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics*; D001427:Bacterial Toxins / Q000235:genetics*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D048909:Diabetes Complications; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D054328:Proton Pump Inhibitors; C031815:toxB protein, Clostridium difficile; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
Clostridium difficile colonization; Clostridium difficile infection; Piperacillin-tazobactam; Proton-pump inhibitors; Risk factors