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Clostridium difficile-Associated Diarrhea: Epidemiology, Risk Factors, and Infection Control

Published online by Cambridge University Press:  02 January 2015

Kwan Kew Lai ,
Zita S. Melvin ,
Mary Jane Menard ,
Helen R. Kotilainen  and
Stephen Baker
Kwan Kew Lai*
Affiliation:
Division of Infectious Disease and Immunology, University of Massachusetts Medical Center, Worcester, Massachusetts
Zita S. Melvin
Affiliation:
Division of Infectious Disease and Immunology, University of Massachusetts Medical Center, Worcester, Massachusetts
Mary Jane Menard
Affiliation:
Division of Infectious Disease and Immunology, University of Massachusetts Medical Center, Worcester, Massachusetts
Helen R. Kotilainen
Affiliation:
Division of Infectious Disease and Immunology, University of Massachusetts Medical Center, Worcester, Massachusetts
Stephen Baker
Affiliation:
Division of Infectious Disease and Immunology, University of Massachusetts Medical Center, Worcester, Massachusetts
*
Division of Infectious Disease and Immunology, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655
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Abstract

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.

Type
Originals Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 9 , September 1997 , pp. 628 - 632
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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