Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital
A case-control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic...
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| Format: | Article |
| Language: | English |
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Wiley
1994-01-01
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| Series: | Canadian Journal of Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/1994/207601 |
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| author | Swapan K Nath Suzette Salama Devia Persaud James H Thornley Ian Smith Gary Foster Coleman Rotstein |
| author_facet | Swapan K Nath Suzette Salama Devia Persaud James H Thornley Ian Smith Gary Foster Coleman Rotstein |
| author_sort | Swapan K Nath |
| collection | DOAJ |
| description | A case-control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic clone of toxigenic C difficile were compared with controls. Eighty controls were selected from a group of 290 controls randomly chosen from the outbreak period. The controls were matched to cases according to age, admitting diagnosis and unit of admission. Seventy (88%) patients in the case group received at least one antibiotic before diarrhea, compared with 37 (46%) patients in the control group. Major risk factors implicated in the development of C difficile diarrhea in hospitalized patients were the following antimicrobial agents: ceftazidime (adjusted odds ratio [aor]=26.01, 95% ci 5.67 to 119.19, P=0.0001); cefuroxime (aor=5.17, ci 1.86 to 14.36, P=0.005); ciprofloxacin (aor=3.81, ci 1.05 to 13.79, P=0.04); and clindamycin (aor=15.16, ci 2.93 to 78.44, P=0.004). This is the first time that the use of ciprofloxacin has been linked to the development of C difficile diarrhea. Use of gastrointestinal drugs (ranitidine, famotidine, cimetidine, omeprazole and sucralfate) was also an added risk (aor=3.20, ci 1.39 to 7.34, P=0.01); however, antineoplastic therapy was not significant (P<0.53). Recognition of the specific high risk drugs may spur more restricted use of these agents, which may help in controlling C difficile diarrhea in hospitalized patients. |
| format | Article |
| id | doaj-art-7f2b28e985b141c6a21d0fd9cb236b57 |
| institution | Kabale University |
| issn | 1180-2332 |
| language | English |
| publishDate | 1994-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Infectious Diseases |
| spelling | doaj-art-7f2b28e985b141c6a21d0fd9cb236b572025-02-03T05:58:46ZengWileyCanadian Journal of Infectious Diseases1180-23321994-01-015627027510.1155/1994/207601Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching HospitalSwapan K Nath0Suzette Salama1Devia Persaud2James H Thornley3Ian Smith4Gary Foster5Coleman Rotstein6Departments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaDepartments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaDepartments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaDepartments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaDepartments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaDepartments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaDepartments of Laboratory Medicine and Pharmacy, and the Division of Infectious Diseases, Henderson General Hospital, Hamilton, Ontario, CanadaA case-control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak of Clostridium difficile diarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic clone of toxigenic C difficile were compared with controls. Eighty controls were selected from a group of 290 controls randomly chosen from the outbreak period. The controls were matched to cases according to age, admitting diagnosis and unit of admission. Seventy (88%) patients in the case group received at least one antibiotic before diarrhea, compared with 37 (46%) patients in the control group. Major risk factors implicated in the development of C difficile diarrhea in hospitalized patients were the following antimicrobial agents: ceftazidime (adjusted odds ratio [aor]=26.01, 95% ci 5.67 to 119.19, P=0.0001); cefuroxime (aor=5.17, ci 1.86 to 14.36, P=0.005); ciprofloxacin (aor=3.81, ci 1.05 to 13.79, P=0.04); and clindamycin (aor=15.16, ci 2.93 to 78.44, P=0.004). This is the first time that the use of ciprofloxacin has been linked to the development of C difficile diarrhea. Use of gastrointestinal drugs (ranitidine, famotidine, cimetidine, omeprazole and sucralfate) was also an added risk (aor=3.20, ci 1.39 to 7.34, P=0.01); however, antineoplastic therapy was not significant (P<0.53). Recognition of the specific high risk drugs may spur more restricted use of these agents, which may help in controlling C difficile diarrhea in hospitalized patients.http://dx.doi.org/10.1155/1994/207601 |
| spellingShingle | Swapan K Nath Suzette Salama Devia Persaud James H Thornley Ian Smith Gary Foster Coleman Rotstein Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital Canadian Journal of Infectious Diseases |
| title | Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital |
| title_full | Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital |
| title_fullStr | Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital |
| title_full_unstemmed | Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital |
| title_short | Drug risk Factors Associated with a Sustained Outbreak of Clostridium difficile Diarrhea in a Teaching Hospital |
| title_sort | drug risk factors associated with a sustained outbreak of clostridium difficile diarrhea in a teaching hospital |
| url | http://dx.doi.org/10.1155/1994/207601 |
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