Drug risk Factors Associated with a Sustained Outbreak ofClostridium difficileDiarrhea in a Teaching Hospital Academic Article uri icon

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  • A case-control study was undertaken to identify and quantify antimicrobial and nonantimicrobial drug risk factors associated with a sustained outbreak ofClostridium difficilediarrhea on two medical (teaching and nonteaching) units and an oncology unit. In total, 80 cases associated with an endemic clone of toxigenicC difficilewere compared with controls. Eighty controls were selected from a group of 290 controls randomly chosen from the outbreak period. The controls were matched to cases according to age, admitting diagnosis and unit of admission. Seventy (88%) patients in the case group received at least one antibiotic before diarrhea, compared with 37 (46%) patients in the control group. Major risk factors implicated in the development ofC difficilediarrhea in hospitalized patients were the following antimicrobial agents: ceftazidime (adjusted odds ratio [aor]=26.01, 95%ci5.67 to 119.19, P=0.0001); cefuroxime (aor=5.17,ci1.86 to 14.36, P=0.005); ciprofloxacin(aor=3.81,ci1.05 to 13.79, P=0.04); and clindamycin(aor=15.16,ci2.93 to 78.44, P=0.004). This is the first time that the use of ciprofloxacin has been linked to the development ofC difficilediarrhea. Use of gastrointestinal drugs (ranitidine, famotidine, cimetidine, omeprazole and sucralfate) was also an added risk(aor=3.20,ci1.39 to 7.34, P=0.01); however, antineoplastic therapy was not significant (P<0.53). Recognition of the specific high risk drugs may spur more restricted use of these agents, which may help in controllingC difficilediarrhea in hospitalized patients.


  • Nath, Swapan K
  • Salama, Suzette
  • Persaud, Devia
  • Thornley, James H
  • Smith, Ian
  • Foster, Gary
  • Rotstein, Coleman

publication date

  • 1994