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Quinolone Use as a Risk Factor for Nosocomial Clostridium difficile-Associated Diarrhea

  • Clarwyn Yip (a1), Mark Loeb (a2) (a3), Suzette Salama (a1), Lorraine Moss (a2) and Jan Olde (a3)...
Abstract<span class='bold'>Objective:</span>

To determine modifiable risk factors for nosocomial Clostridium difficile-associated diarrhea (CDAD).

<span class='bold'>Design:</span>

Case-control study.

<span class='bold'>Setting:</span>

300-bed tertiary-care hospital.

<span class='bold'>Participants:</span>

Hospital inpatients present during the 3-month study period.

<span class='bold'>Methods:</span>

Case-patients identified with nosocomial CDAD over the study period were compared to two sets of control patients: inpatients matched by age, gender, and date of admission; and inpatients matched by duration of hospital stay. Variables including demographic data, comorbid illnesses, antibiotic exposure, and use of gastrointestinal medications were assessed for case- and control-patients. Conditional logistic regression was performed to identify risk factors for nosocomial CDAD.

<span class='bold'>Results:</span>

27 case-patients were identified and were compared to the two sets of controls (1:1 match for each comparison set). For the first set of controls, use of ciprofloxacin (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.2-24.8; P=.03) was the only variable that remained significant in the multivariable model. For the second set of controls, prior exposure to cephalosporins (OR, 6.7; CL,5, 1.3-33.7; P=.02) and to ciprofloxacin (OR, 9.5; CI95, 1.01-88.4; P=.05) were kept in the final model.

<span class='bold'>Conclusions:</span>

Along with cephalosporins, prior quinolone use predisposed hospitalized patients to nosocomial CDAD. Quinolones should be used judiciously in acute-care hospitals, particularly in those where CDAD is endemic.

Corresponding author
Hamilton Health Sciences Corporation, 711 Concession St, Hamilton, Ontario L8V1C3, Canada
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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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