title: Characteristics and Antibiotic Use Associated With Short-Term Risk of Clostridium difficile Infection Among Hospitalized Patients.
abstract: OBJECTIVE
  Polymerase chain reaction (PCR) has been shown to have an excellent sensitivity and specificity for the detection of Clostridium difficile infection (CDI). Little is known about risk factors for CDI within 14 days of an initial negative test. We sought to determine the characteristics among hospitalized patients associated with risk of short-term acquisition of CDI.
  
  
  METHODS
  A case-control study was conducted. Cases were patients who converted from PCR negative to positive within 14 days. Each case was matched with three controls. Conditional logistic regression was used to estimate the association between patient characteristics and CDI.
  
  
  RESULTS
  Of the 30 patients in our study who had a positive PCR within 14 days of a first negative PCR (cases), 15 (50%) occurred within 7 days of the initial test. Cases had a higher proportion of intravenous vancomycin use in the previous 8 weeks (odds ratio [OR], 3.38; 95% confidence interval [CI], 1.34-8.49) and were less likely to have recent antiviral agent use (OR, 0.30; 95% CI, 0.11-0.83) compared with controls.
  
  
  CONCLUSIONS
  In hospitalized patients, treatment with intravenous vancomycin within the prior 8 weeks of a first negative PCR test for C difficile is a risk factor for short-term risk for hospital-acquired CDI. Repeat testing guidelines for C difficile PCR should take into consideration patients who may be at high risk for short-term acquisition of CDI.
authors.affiliation: From the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA;
authors.forename: Sol del Mar
authors.initials: Sdel M
authors.lastname: Aldrete
authors.affiliation: Division of Epidemiology and Biostatistics, Georgia State University School of Public Health, Atlanta;
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: From the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA;
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Friedman-Moraco
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, NC;
authors.forename: Austin W
authors.initials: AW
authors.lastname: Chan
authors.affiliation: Emory Healthcare, Atlanta, GA; and.
authors.forename: Grier G
authors.initials: GG
authors.lastname: Banks
authors.affiliation: From the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Burd
authors.affiliation: From the Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA. colleen.kraft@emory.edu.
authors.forename: Colleen S
authors.initials: CS
authors.lastname: Kraft
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003428:Cross Infection / Q000175:diagnosis*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D014640:Vancomycin
keywords: CDI; Clostridium difficile; Molecular; PCR; Repeat