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

Clarwyn Yip , MD, Mark Loeb , MD, MSc, Suzette Salama , PhD, Lorraine Moss , BSc and Jan Olde , RN
Infection Control and Hospital Epidemiology
Vol. 22, No. 9 (September 2001), pp. 572-575
DOI: 10.1086/501954
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Page Count: 4
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Quinolone Use as a Risk Factor for Nosocomial Clostridium difficile‐Associated Diarrhea
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OBJECTIVE.  To determine modifiable risk factors for nosocomial Clostridium difficile‐associated diarrhea (CDAD). DESIGN.  Case‐control study. SETTING.  300‐bed tertiary‐care hospital. PARTICIPANTS.  Hospital inpatients present during the 3‐ month study period. METHODS.  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. RESULTS.  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; CI95, 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. CONCLUSIONS.  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..

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