Risk Factors for Clostridium difficile Carriage and C difficile-Associated ...

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Dec 7, 1989 - of disease ranging from asymptomatic carriage to antibiotic- associated diarrhea, colitis, or pseudomembranous colitis [1,. 2]. Recently, reports ...
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Risk Factors for Clostridium difficile Carriage and C difficile-Associated Diarrhea in a Cohort of Hospitalized Patients Lynne V. McFarland, Christina M. Surawicz, and Walter E. Stamm

From the Department of Epidemiology, School of Public Health, and the Department of Medicine, University of Washington, Kbshington. School of Medicine, Seattle

Acquisition of Clostridium difficile occurs frequently in hospitalized patients and has been associated with a spectrum of disease ranging from asymptomatic carriage to antibiotic[I, associated diarrhea, colitis, or pseudomembranous colitis [1, 2]. Recently, reports of outbreaks of both C. difficile-associated diarrhea and colitis have been reported in hospitals [3-6]. Although antibiotic use and other factors have been associated with C. difficile colitis and pseudomembranous colitis, most studies identifying these risk factors have been retrospective or cross-sectional, have not identified asymptomatic carriers, have not differentiated nosocomial from community-acquired cases, or have been conducted during outbreaks of infection [5, 7-12]. Our main objective was to identify risk factors associated either with asymptomatic carC difficile or with the development of C. C difficile-asriage of C. sociated diarrhea in a prospectively followed cohort ofpatients. We also examined the frequency of stool cytotoxin in patients who developed C. difficile-associated diarrhea while enrolled in our study.

Received. 7 December 1989; revised revised. 14 February 1990. Received Presented in part at the Society for Epidemiologic Research meeting, Vancouver, British Columbia, June 1988 (Am J EpidemioI1988;128:940 [abstract 183]). Informed consent was obtained from all patients or their guardians, and approved. by the University of Washington Human the study protocol was approved Subjects Review Committee. Reprints and correspondence: Dr. Lynne V. McFarland, Department of Medicinal Chemistry, BG-20, 311 Bagley Hall, University of Washington, Seattle WA 98195. The Journal of Infectious Diseases 1990;162:678-684 1990;162:678-6114 © 1990 by The University of Chicago. All rights reserved. 0022-1899/90/6203-0017$01.00

Materials and Methods Study cohort. The study cohort consisted of consecutive consenting patients admitted to an adult general medicine ward at Harborview Medical Center (Seattle) over an II-month period. Patients were approached within 48 h of admission to solicit participation. Exclusion criteria included an expected length of stay