Abstract
Clostridium difficile infection
(CDI) is the most common cause of infectious healthcare-associated
diarrhea. Factors associated with the short-term risk of CDI have
not been evaluated. This case-control study examined patient
characteristics associated with short-term risk of CDI within 14
days among hospitalized patients with multiple tests who initially
test negative. Patients were defined as cases if they had initially
tested negative by polymerase chain reaction (PCR) followed by a
positive PCR test within 14 days. Controls were drawn from a
population of patients from the same time period who had repeat
testing and no positive result within 14 days of an initial
negative PCR test. Each case was matched with three controls by age
and days of hospitalization prior to first PCR test. Conditional
logistic regression was used to assess the association between
patient characteristics and antibiotic classes and short-term risk
of C. difficile. Of 750 patients who had a test repeated
within 14 days, 30 acquired C. difficile.There was a trend
for patients with recent gastrointestinal procedure (odds ratio
[OR] 2.41, 95% confidence interval [CI] 0.84, 6.88) for short-term
acquisition of CDI. Cases had a higher proportion of recent
intravenous vancomycin use within 8 weeks prior to first PCR test
(OR 3.38, 95% CI 1.34, 8.49). Controls had a higher proportion of
recent antiviral use (OR 0.30, 95% CI 0.11, 0.83) as compared to
cases. Only 4.0% (30/750) of this study population had short-term
acquisition of C. difficile and 1.3% (10/750) of the
short-term cases of CDI were detected within 7 days. The
association with previous intravenous vancomycin use previously has
not been described in patients with short-term CDI. The practical
implications for this in terms of repeated testing may include
eliciting this antibiotic history when clinicians request testing
earlier than 7 days in a hospitalized patient.
Table of Contents
INTRODUCTION...1
BACKGROUND...3
METHODS...7
RESULTS...11
DISCUSSION...15
REFERENCES...22
TABLES AND FIGURES...26
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