Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control
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Analysis of Variance; Anti-Bacterial Agents; Case-Control Studies; Clostridium Infections; *Clostridium difficile; Cross Infection; Diarrhea; Female; Handwashing; Hospitals, Teaching; Humans; Incidence; Infection Control; Logistic Models; Male; Massachusetts; Middle Aged; Odds Ratio; Risk Factors; Statistics, Nonparametric; Universal Precautions
Immunology and Infectious Disease
OBJECTIVES: To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development.
SETTING: 370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year.
METHODS: Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD.
RESULTS: From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P = .0001 and .0203, respectively) were found to be significant.
CONCLUSION: Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.
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Citation: Infect Control Hosp Epidemiol. 1997 Sep;18(9):628-32.