Underlying Disease Severity as a Major Risk Factor for Nosocomial <i>Clostridium difficile</i> Diarrhea

Kyne, Lorraine; Sougioultzis, Stavros; McFarland, Lynne V.; Kelly, Ciarán P.

doi:10.1086/501989

Cited by 226 publications

(124 citation statements)

References 40 publications

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“…For example, Barbut et al (1996) reported a prevalence of 10 . 5 % among hospitalized patients in France whereas Kyne et al (2002a) observed an 11 % incidence in a prospective cohort study of 252 hospitalized patients receiving antibiotics.…”

Section: Discussionmentioning

confidence: 96%

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Delmée

Broeck

Simon

et al. 2005

Journal of Medical Microbiology

147

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A routine protocol for diagnosing Clostridium difficile-associated diarrhoea (CDAD) based on both faecal-cytotoxin detection and toxigenic culture was adopted by the microbiology laboratory of the St Luc-UCL University Hospital in Brussels in 1997. A toxigenic culture is a faecal culture followed, in the case of positivity, by a direct immunoassay on colonies to detect toxin A production. The results obtained over the past 7 years in the hospital are reviewed here. A total of 10 552 diarrhoeal stools from 7042 patients were analysed, of which 9494 were negative for all tests. A total of 1058 samples (10 %) from 794 patients were culture-positive, of which 460 (4 . 4 %) were positive for a faecal cytotoxin. The remaining 598 cultures were tested for toxin A on colonies; 355 of them were positive, which is 3 . 4 % of the total, and the remaining 243 (2 . 3 %) were negative. The positivity of the faecalcytotoxin assay was statistically linked to the number of colonies observed on the culture plate. In conclusion, over a 7 year period, toxigenic culture allowed the diagnosis of 355 cases of CDAD that would have been missed by a protocol using a faecal-cytotoxin assay alone. In terms of both patient care, prevention of environmental contamination and prevention of risk of a hospital outbreak, it is proposed that these results justify the recommendation to perform both faecal-toxin assay and culture in routine medical practice.

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Section: Discussionmentioning

confidence: 96%

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Delmée

Broeck

Simon

et al. 2005

Journal of Medical Microbiology

147

View full text Add to dashboard Cite

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“…We were unable to acquire data on comorbid illness burden or severity of underlying disease both of which have been identified as significant risk factors for CDI in other studies. 7,42 Our data originate from administrative databases, not specifically designed for research and therefore subject to various previously identified problems such as data-entry errors or omissions, linking data from a dynamic database to a static database and unavailable data that could be useful in the analysis such as comorbidity, severity of illness or mortality measures. 43 We also did not have preadmission drug exposure, such that the effect measured only reflects inpatient use.…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

Dalton

Lye-Maccannell

Henderson

et al. 2009

Aliment Pharmacol Ther

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“…A number of authors have sought to define patientlevel risk factors that predispose patients to CDAD. Most such analyses have examined patient demographics [7][8][9], comorbid conditions [10][11][12], clinical variables [7,8], and antibiotic treatment characteristics [7,8,13]. Patient-level risk factors have been used to help develop treatment algorithms [14], and may also be useful in developing prevention and control measures.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Clostridium difficile colitis infections in hospitals

et al. 2007

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Hospital-level predictors of high rates of 'Clostridium difficile-associated disease' (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with 'high CDAD' rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies. KeywordsArizona, California, clostridium difficile, cross infection, enterocolitis, pseudomembranous, geography, hospitals, humans, Minnesota, risk factors, urban population SUMMARYHospital-level predictors of high rates of ' Clostridium difficile-associated disease ' (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD ; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with 'high CDAD ' rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies.

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Underlying Disease Severity as a Major Risk Factor for Nosocomial Clostridium difficile Diarrhea

Cited by 226 publications

References 40 publications

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low‐endemicity, non‐outbreak hospital setting

Predictors of Clostridium difficile colitis infections in hospitals

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