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Difference in the Incidence of Clostridium difficile Among Patients Infected With Human Immunodeficiency Virus Admitted to a Public Hospital and a Private Hospital

  • Joseph J. Pulvirenti (a1), Dale N. Gerding (a2), Catherine Nathan (a1), Irfan Hafiz (a1), Tarun Mehra (a3), Dayle Marsh (a1), Frank Kocka (a1), Thomas Rice (a1), Staci A. Fischer (a4), John Segreti (a4) and Robert A. Weinstein (a1)...
Abstract
Objective:

To compare the occurrence of Clostridium difficile among inpatients infected with human immunodeficiency virus (HPV) in two different hospitals.

Design:

Prospective, observational study.

Setting:

Specialized HPV inpatient units.

Patients:

HIV-infected inpatients at Cook County Hospital (CCH) and Rush Presbyterian St. Luke's Medical Center (RPSLMC).

Interventions:

A clinical and epidemiologic assessment of patient risk factors for C. difficile was performed. C. difficile isolates found on stool, rectal, and environmental cultures were typed by pulsed-field gel electrophoresis.

Results:

Twenty-seven percent of patients admitted to CCH versus 4% of patients admitted to RPSLMC had positive cultures for C. difficile (P = .001). At CCH, 14.7% of environmental cultures were positive versus 2.9% at RPSLMC (P = .002). Risk factors for C. difficile acquisition included hospitalization at CCH, more severe HrV, use of acyclovir and H2-blockers, and longer hospital stay. Patients admitted to CCH were taking more antibiotics, had longer hospital stays, and more frequently had a history of C. difficile infection. During the study, two strains (CD1A and CD4) extensively contaminated the CCH environment. However, only CD1A caused an outbreak.

Conclusions:

The C. difficile acquisition rate at CCH was sevenfold higher than that at RPSLMC, and CCH had a more contaminated environment Differences in patient acquisition rates likely reflect a greater prevalence of traditional C. difficile risk factors and a concurrent outbreak at CCH. Although two strains heavily contaminated the environment at CCH, only one caused an outbreak, suggesting that factors other than the environment are important in initiating C. difficile outbreak.

Copyright
Corresponding author
Division of Infectious Diseases, Cook County Hospital, 1835 West Harrison, Chicago, IL 60612
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1. MH Samore , L Venkataraman , PC DeGirolami , RD Arbeit , AW Karchmer . Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996; 100:3240.

3. MW Climo , DS Israel , ES Wong , D Williams , P Coudron , SM Markowitz . Hospital wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989995.

6. TDI Cartmill , H Panigrahi , MA Worsley , DC McCann , CN Nice , E Keith . Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J Hosp Infect 1994;27:115.

7. SE Brooks , RO Veal , M Kramer , L Dore , N Schupf , M Adachi . Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single use disposables. Infect Control Hosp Epidemiol 1992;13:98103.

10. DN Gerding , JS Brazier . Optimal methods for identifying Clostridium difficile infections. Clin Infect Dis 1993;16(suppl 4):S439S442.

19. CR Clabots , S Johnson , MM Olson , LR Peterson , DN Gerding . Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992; 166:561567.

20. LV McFarland , CM Surawicz , WE Stamm . Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678684.

22. LV McFarland , ME Mulligan , RY Kwok , WE Stamm . Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204210.

25. MH Samore , PC DeGirolami , A Tlucko , DA Lictenberg , ZA Melvin , AW Karchmer . Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clin Infect Dis 1994;18:181187.

26. O Karlstrom , B Fryklund , K Tullus , L Burman . A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 1998;26:141145.

27. S Johnson , MH Samore , KA Farrow , et al. Epidemics of diarrhea caused by clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341:16451651.

28. SP Borriello , JM Ketley , TJ Mitchell . Clostridium difficile: a spectrum of virulence and analysis of putative virulence determinants in the hamster model of antibiotic-associated colitis. J Med Microbiol 1987;24:5364.

79. DW Burdon . Clostridium difficile: the epidemiology and prevention of hospital-acquired infection. Infection 1982;10:203204.

144. CE Hughes , RL Gebhard , LR Peterson , DN Gerding . Efficacy of routine fiberoptic endoscope cleaning and disinfection for killing Clostridium difficile. Gastrointest Endosc 1986;32:79.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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