Epidemic Clostridium difficile-associated diarrhea: role of second- and third-generation cephalosporins.

Abstract:

OBJECTIVE:To better define the role of multiple risk factors for cytotoxic Clostridium difficile-associated diarrhea. DESIGN:Case-control study. SETTING:A Veterans Affairs Medical Center. PATIENTS:Thirty-three case patients with C difficile-associated diarrhea. Two control groups were used: one group consisted of 32 patients from the same ward as the case patients, and one group consisted of 34 patients with nosocomial diarrhea and negative C difficile toxin assays. INTERVENTION:None. RESULTS:Multivariate analyses revealed that exposure to second- or third-generation cephalosporins was the most important independent risk factor, even after controlling for other antimicrobial use (odds ratio [OR] = 8.3, 95% confidence interval [CI95] = 1.4 to 48.9 compared to ward controls; OR = 9.6, CI95 = 2.1 to 44.1 compared with diarrhea controls). Persons exposed to two or more antimicrobials simultaneously were at substantially elevated risk (OR = 18.7, CI95 = 4.1 to 85.8 compared with ward controls; OR = 21.5, CI95 = 3.2 to 141.9 compared with diarrhea controls). CONCLUSION:Physicians should consider carefully the appropriateness of second- and third-generation cephalosporin use and combination antimicrobial therapy, especially during nosocomial C difficile-associated diarrhea outbreaks (Infect Control Hosp Epidemiol 1994;15:88-94).

authors

Nelson DE,Auerbach SB,Baltch AL,Desjardin E,Beck-Sague C,Rheal C,Smith RP,Jarvis WR

doi

10.1086/646867

subject

Has Abstract

pub_date

1994-02-01 00:00:00

pages

88-94

issue

2

eissn

0899-823X

issn

1559-6834

journal_volume

15

pub_type

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