Hsiao-Ju Lin1, Yuan-Pin Hung2, Hsiu-Chuan Liu3, Jen-Chieh Lee4, Chih-I Lee1, Yi-Hui Wu5, Pei-Jane Tsai6, Wen-Chien Ko7. 1. Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan. 2. Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan. 3. Department of Experiment and Diagnosis, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan. 4. Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan. 5. Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan. 6. Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: peijtsai@mail.ncku.edu.com. 7. Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
Abstract
BACKGROUND: Patients with toxigenic Clostridium difficile colonization (tCDC) are at risk of developing C. difficile-associated diarrhea (CDAD). However, the risk factors of hospitalized patients with tCDC developing CDAD are not clear. METHODS: We conducted an 18-month prospective study at a medical ward in a district hospital in southern Taiwan. Within 48 hours of admission, weekly stool samples from asymptomatic hospitalized patients were obtained to detect fecal CDC. A polymerase chain reaction for tcdB was performed to determine toxigenic isolates. CDAD was diagnosed if the patient had diarrhea and toxigenic C. difficile present in a stool sample. RESULTS: A total 483 patients with stool samples were eligible for the study. Eighty-six (17.8%) patients had tCDC after screening, of whom 14 (16.3%) developed CDAD during follow-up. Among those with tCDC, patients with subsequent CDAD were more likely to have diabetes mellitus (p = 0.01) and to have received piperacillin-tazobactam (p = 0.04), or proton-pump inhibitors (PPIs; p = 0.04) than those without developing CDAD. The variables were statistically significant as determined by multivariate analysis. However, the 60-day crude mortality rates among tCDC patients with and without subsequent development of CDAD were similar. CONCLUSION: Diabetes mellitus and recent receipt of piperacillin-tazobactam or PPIs are independent risk factors for the development of CDAD among hospitalized patients with tCDC.
BACKGROUND:Patients with toxigenic Clostridium difficile colonization (tCDC) are at risk of developing C. difficile-associated diarrhea (CDAD). However, the risk factors of hospitalized patients with tCDC developing CDAD are not clear. METHODS: We conducted an 18-month prospective study at a medical ward in a district hospital in southern Taiwan. Within 48 hours of admission, weekly stool samples from asymptomatic hospitalized patients were obtained to detect fecal CDC. A polymerase chain reaction for tcdB was performed to determine toxigenic isolates. CDAD was diagnosed if the patient had diarrhea and toxigenic C. difficile present in a stool sample. RESULTS: A total 483 patients with stool samples were eligible for the study. Eighty-six (17.8%) patients had tCDC after screening, of whom 14 (16.3%) developed CDAD during follow-up. Among those with tCDC, patients with subsequent CDAD were more likely to have diabetes mellitus (p = 0.01) and to have received piperacillin-tazobactam (p = 0.04), or proton-pump inhibitors (PPIs; p = 0.04) than those without developing CDAD. The variables were statistically significant as determined by multivariate analysis. However, the 60-day crude mortality rates among tCDCpatients with and without subsequent development of CDAD were similar. CONCLUSION:Diabetes mellitus and recent receipt of piperacillin-tazobactam or PPIs are independent risk factors for the development of CDAD among hospitalized patients with tCDC.
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