title: Clinical characteristics of Clostridium difficile-associated diarrhea among patients in a tertiary care center in China.
abstract: OBJECTIVE
  This study investigated the incidence, risk factors, and clinical characteristics of Clostridium difficile-associated diarrhea (CDAD) in Chinese patients.
  
  
  METHODS
  Fecal specimens of patients with antibiotic-associated diarrhea (AAD) were collected to test C. difficile toxin A and B using enzyme-linked fluorescent assay to identify CDAD. By adopting a nested case-control design, the matched people (ratio 1:3) without AAD were included as controls.
  
  
  RESULTS
  Out of 56,172 inpatients, 39,882 (71.0%) used antibiotics, 470 suffered from AAD, and 93 were diagnosed with CDAD. The incidence of nosocomial CDAD was 166 per 100,000. The proportion of CDAD in AAD was 19.8%. CDAD patients presented with more severe clinical manifestations and exhibited more concurrent illness. Logistic regression analysis showed the risk factors of CDAD: advanced age, nasogastric tube-feeding, high APACHE II scores, high level of serum C-reaction protein, low level of serum albumin, severe underlining disease or comorbidity, and number of antibiotic intake. Twenty-nine patients (31.2%) were cured with vancomycin, 54 (58.1%) were cured after dual therapy of vancomycin plus metronidazole, 7 (7.5%) died of underlying diseases aggravated with CDAD, and 3 (3.2%) were transferred to other hospitals for personal reasons.
  
  
  CONCLUSIONS
  The incidence of nosocomial CDAD in China was high. Some risk factors could predispose CDAD.
authors.affiliation: Yongqiang Li, Department of Gastroenterology, Guangzhou Digestive Diseases Center, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong, China.
authors.forename: Yongqiang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Yi Huang, Department of Gastroenterology, Guangzhou Digestive Diseases Center, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Yuyuan Li, Department of Gastroenterology, Guangzhou Digestive Diseases Center, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong, China.
authors.forename: Yuyuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Yuqiang Nie, Department of Gastroenterology, Guangzhou Digestive Diseases Center, Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong, China.
authors.forename: Yuqiang
authors.initials: Y
authors.lastname: Nie
keywords: Antibiotic-associated diarrhea; Clostridium difficile; Incidence; Risk factors