Risk factors of Clostridium difficile infections among patients in a university hospital in Shanghai, China

• Published in: Anaerobe 2014-12, Vol.30, p.65-69
• Main Authors: Huang, Haihui, Wu, Shi, Chen, Renjie, Xu, Shaohua, Fang, Hong, Weintraub, Andrej, Nord, Carl Erik
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Case-control study; China - epidemiology; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium difficile infection; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Cohort Studies; Cross Infection - epidemiology; Cross Infection - microbiology; Diarrhea - epidemiology; Diarrhea - microbiology; Diarrhoea; Female; Hospitals, University; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Risk factor; Risk Factors; Shanghai, China; Young Adult
• ISSN: 1075-9964; 1095-8274
• DOI: 10.1016/j.anaerobe.2014.08.015

Clostridium difficile infection (CDI) is an increasing concern in China. However, the risk factors of CDI are rarely reported in the Chinese population. A prospective observational study was therefore conducted among patients with hospital-acquired C. difficile diarrhoea and the risk factors of CDI in a retrospective case-control study. The CDI patients were compared with the non-CDI diarrhoeal patients and those without diarrhoea, respectively. The recurrent CDI patients were compared with the corresponding non-recurrent CDI patients and those without diarrhoea, respectively. Overall, of the 240 patients with hospital-acquired diarrhoea 90 (37.5%) were diagnosed as CDI, and 12 (13.3%) of the 90 CDI patients experienced recurrence. Multivariate analysis indicated that renal disease, malignancy, hypoalbuminemia, prior antibiotic treatment, chemotherapy, nasogastric tube use, length of stay >14 days and intra-abdominal surgery, defined daily dose of antimicrobial agents ≥19, prior use of more than three antimicrobial agents, and use of carbapenems were independent risk factors for the first episode of CDI. Use of laxatives, the first- and second-generation narrow-spectrum cephalosporins or metronidazole was identified as protective factors. It is necessary to make testing of C. difficile available as a routine practice and control these risk factors in Chinese hospitals to avoid CDI outbreaks. •38% of the patients had CDI.•Risk factors were renal disease, malignancy, hypoalbuminemia, chemotherapy, antibiotic treatment, intraabdominal surgery.•Use of laxatives, narrow-spectrum cephalosporins and metronidazole were protective factors.