Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-02T10:24:22.563Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Acquisition of Clostridium difficile–Associated Diarrhea among Outpatients at a Cancer Hospital

Published online by Cambridge University Press:  21 June 2016

Tara N. Palmore ,
SeJean Sohn ,
Sharp F. Malak ,
Janet Eagan  and
Kent A Sepkowitz
Tara N. Palmore
Affiliation:
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
SeJean Sohn
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Sharp F. Malak
Affiliation:
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Janet Eagan
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Kent A Sepkowitz*
Affiliation:
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021., sepkowik@mskcc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Clostridium difficile-associated diarrhea (CDAD) is an important infection in hospital settings. Its impact on outpatient care has not been well defined.

Objective:

To examine risk factors of ambulatory cancer patients with CDAD.

Design:

Case-control study.

Setting:

Memorial Sloan-Kettering Cancer Center, a tertiary-care hospital.

Methods:

Cases of CDAD among oncology outpatients from January 1999 through December 2000 were identified via positive C. difficile toxin assay results on stool specimens sent from clinics or the emergency department. A 1:3 matched case-control study examined exposures associated with CDAD.

Results:

Forty-eight episodes of CDAD were identified in cancer outpatients. The mean age was 51 years; 44% were female. Forty-one (85%) had received antibiotics within 60 days of diagnosis, completing courses a median of 16.5 days prior to diagnosis. Case-patients received longer courses of first-generation cephalosporins (4.8 vs 3.2 days; P = .03) and fluoroquinolones (23.6 vs 8 days; P < .01) than did control-patients. Those receiving clindamycin were 3.9-fold more likely to develop CDAD (P < .01). For each additional day of clindamycin or third-generation cephalosporin exposure, patients were 1.29- and 1.26-fold more likely to develop CDAD (P < .01 and .04, respectively). The 38 CDAD patients hospitalized during the risk period (79.2%) spent more time as inpatients than did control-patients (19.3 vs 9.7 days; P <. 001).

Conclusions:

Antibiotic use, especially with cephalosporins and clindamycin, and prolonged hospitalization contributed to the development of CDAD. Outpatient CDAD appears to be most strongly related to inpatient exposures; reasons for the delayed development of symptoms are unknown.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 8 , August 2005 , pp. 680 - 684
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McFarland, LV, Stamm, WE. Review of Clostridium difficile-associated diseases. Am J Infect Control 1986;14:99–109.CrossRefGoogle ScholarPubMed
2.Blot, E, Escande, MC, Besson, D, et al.Outbreak of Clostridium difficile-related diarrhoea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 2003;53:187–192.CrossRefGoogle Scholar
3.Cumming, AD, Thomson, BJ, Sharp, J, Poxton, IR, Fraser, A. Diarrhoea due to Clostridium difficile associated with antibiotic treatment in patients receiving dialysis: the role of cross infection. Br Med J 1986;292:238–239.CrossRefGoogle ScholarPubMed
4.Boone, N, Eagan, JA, Gillern, P, Armstrong, D, Sepkowitz, KA. Evaluation of an interdisciplinary re-isolation policy for patients with previous Clostridium difficile diarrhea. Am J Infect Control 1998;26:584–587.CrossRefGoogle ScholarPubMed
5.Levy, DG, Stergachis, A, McFarland, LV, et al.Antibiotics and Clostridium difficile diarrhea in the ambulatory care setting. Clin Ther 2000;22:91–102.CrossRefGoogle ScholarPubMed
6.Hirschhorn, LR, Trnka, Y, Onderdonk, A, Lee, ML, Platt, R. Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis 1994;169:127–133.CrossRefGoogle ScholarPubMed
7.Riley, TV, Cooper, M, Bell, B, Golledge, CL. Community-acquired Clostridium difficile-associated diarrhea. Clin Infect Dis 1995;20(suppl 2): S263–S265.CrossRefGoogle ScholarPubMed
8.Riley, TV, Wetherall, F, Bowman, J, Mogyorosy, J, Golledge, CL. Diarrheal disease due to Clostridium difficile in general practice. Pathology 1991;23:346–349.CrossRefGoogle ScholarPubMed
9.Privitera, G, Scarpellini, P, Ortisi, G, Nicastro, G, Nicolin, R, de Lalla, F. Prospective study of Clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery. Anti-microb Agents Chemother 1991;35:208–210.CrossRefGoogle ScholarPubMed
10.Block, BS, Mercer, LJ, Ismail, MA, Moawad, AH. Clostridium difficile-associated diarrhea follows perioperative prophylaxis with cefoxitin. Am J Obstet Gynecol 1985;153:835–838.CrossRefGoogle ScholarPubMed
11.Freiman, JP, Graham, DJ, Green, L. Pseudomembranous colitis associated with single-dose cephalosporin prophylaxis. JAMA 1989;262:902.CrossRefGoogle ScholarPubMed
12.Bombassaro, AM, Wetmore, SJ, John, MA. Clostridium difficile colitis following antibiotic prophylaxis for dental procedures. J Can Dent Assoc 2001;67:20–22.Google ScholarPubMed
13.Teasley, DG, Gerding, DN, Olson, MM, et al.Prospective randomised trial of metronidazole versus vancomycin for Clostridium difficile-associated diarrhoea and colitis. Lancet 1983;2:1043–1046.CrossRefGoogle ScholarPubMed
14.Dharmarajan, TS, Patel, B, Sipalay, M, Norkus, EPClostridium difficile colitis in older adults in long-term facilities and the community: do their outcomes differ? J Am Med Dir Assoc 2000;1:58–61.Google ScholarPubMed
15.Chang, VT, Nelson, K. The role of physical proximity in nosocomial diarrhea. Clin Infect Dis 2000;31:717–722.CrossRefGoogle ScholarPubMed