Risk factors for Clostridium difficile toxin-positive nosocomial diarrhoea

Abstract

Data were retrieved from the records of all patients from whom stool was sent for Clostridium difficile toxin testing during the year 2001. Toxin-positive and -negative patients were compared by bivariate analysis and regression models. Eight hundred samples from 610 patients were sent for C. difficile toxin testing. Charts of 535 patients (88%) were available for analysis. Of those, 17% had a positive toxin test whilst 83% had a negative toxin test. There was no difference in the number of daily bowel movements between the two groups. Toxin-positive patients were older ( P < 0.0001), more often came from nursing homes ( P < 0.05), had higher leukocyte counts ( P < 0.001), higher blood urea nitrogen ( P < 0.01), lower serum albumin ( P < 0.01) and more often received diuretics ( P < 0.01) and clindamycin ( P < 0.05). Logistic regression analysis showed that previous antibiotic-associated diarrhoea was the most significant risk factor for toxin-positive diarrhoea ( P < 0.001), followed by clindamycin treatment ( P < 0.005), diuretics ( P < 0.005) and older age ( P < 0.05). Another logistic model showed the contribution of macrolides ( P < 0.05) to the development of hospital-acquired diarrhoea.