Abstract

Objective:This study investigated the incidence, risk factors, and clinical characteristics of Clostridium difficile-associated diarrhea (CDAD) in Chinese patients.Methods:Fecal specimens of patients with antibiotic-associated diarrhea (AAD) were collected to test C. difficile toxin A and B using enzyme-linked fluorescent assay to identify CDAD. By adopting a nested case-control design, the matched people (ratio 1:3) without AAD were included as controls.Results:Out of 56,172 inpatients, 39,882 (71.0%) used antibiotics, 470 suffered from AAD, and 93 were diagnosed with CDAD. The incidence of nosocomial CDAD was 166 per 100,000. The proportion of CDAD in AAD was 19.8%. CDAD patients presented with more severe clinical manifestations and exhibited more concurrent illness. Logistic regression analysis showed the risk factors of CDAD: advanced age, nasogastric tube-feeding, high APACHE II scores, high level of serum C-reaction protein, low level of serum albumin, severe underlining disease or comorbidity, and number of antibiotic intake. Twenty-nine patients (31.2%) were cured with vancomycin, 54 (58.1%) were cured after dual therapy of vancomycin plus metronidazole, 7 (7.5%) died of underlying diseases aggravated with CDAD, and 3 (3.2%) were transferred to other hospitals for personal reasons.Conclusion:The incidence of nosocomial CDAD in China was high. Some risk factors could predispose CDAD.

Highlights

  • Clostridium difficile (C. difficile)-associated diarrhea (CDAD) is a common cause of infectious diarrhea in hospitals, which usually occurs as a compli

  • We studied the incidence, risk factors, and clinical characteristics of Clostridium difficile-associated diarrhea (CDAD) in Chinese patients

  • The patients who exhibited diarrhea after being administered antibiotics for at least 3 days were selected according to the diagnostic criteria issued by Health Ministry of China,[6] which was adapted from the guideline of American College of Gastroenterology.[7]

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Summary

Introduction

Clostridium difficile (C. difficile)-associated diarrhea (CDAD) is a common cause of infectious diarrhea in hospitals, which usually occurs as a compli-. Yuqiang Nie, 1-4: Department of Gastroenterology, Guangzhou Digestive Diseases Center, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangdong, China. Correspondence: November 20, 2015 April 12, 2016 cation of antibiotic therapy. CDAD is becoming a growing worldwide health threat with an incidence of approximately 100 per million and a mortality of 1%–2.5% in western countries.[1] controlling the spread of this infection is urgently needed

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