Clostridium Difficile-Associated Diarrhea: Epidemiology, Risk Factors, and Infection Control
| Autor: | Mary Jane Menard, Stephen P. Baker, Helen Rosen Kotilainen, Zita S. Melvin, Kwan Kew Lai |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Diarrhea
Male Microbiology (medical) medicine.medical_specialty Epidemiology Attack rate Statistics Nonparametric Risk Factors Internal medicine Odds Ratio Humans Medicine Infection control Risk factor Hospitals Teaching Analysis of Variance Cross Infection Infection Control Respiratory tract infections Clostridioides difficile business.industry Incidence Incidence (epidemiology) Odds ratio Middle Aged Clostridium difficile bacterial infections and mycoses Universal Precautions Anti-Bacterial Agents Ciprofloxacin Logistic Models Infectious Diseases Massachusetts Case-Control Studies Immunology Clostridium Infections Female business Hand Disinfection medicine.drug |
| Zdroj: | Infection Control and Hospital Epidemiology. 18:628-632 |
| ISSN: | 1559-6834 0899-823X 0195-9417 |
| DOI: | 10.2307/30141489 |
| Popis: | Objectives: To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development. Setting: 370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year. Methods: Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD. Results: From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P=.0001 and .0203, respectively) were found to be significant. Conclusion: Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline. |
| Databáze: | OpenAIRE |
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