Risk factors for Clostridium difficile-associated diarrhea on an adult hematology-oncology ward

  • A. H. Gifford
  • K. B. Kirkland


Nosocomial diarrhea caused by Clostridium difficile causes significant morbidity and mortality in an increasing proportion of hospitalized patients annually. This case-control study of patients admitted to the hematology-oncology ward of a tertiary academic medical center over a 2-year period demonstrates that patients with Clostridium difficile-associated diarrhea (CDAD) were 22 times more likely than ward-matched controls with diarrhea to have received any antibiotic either during hospitalization or in the month preceding admission (p < 0.005), and they were nearly three times as likely as controls to have received a cephalosporin during the same period (p < 0.005). Diarrhea among lung cancer patients was approximately three times more likely to be caused by this organism than to be due to other causes (p = 0.04). A trend towards CDAD patients receiving higher numbers of different antibiotics during hospitalization (3.3 vs. 2.6, 95%CI −1.42–0.02, p = 0.06) was noted. Administration of interleukin-2 either during hospitalization or in the 30 days preceding admission was seven times more likely to have occurred in CDAD cases (p = 0.04), raising the question of whether or not this agent increases risk.


Clostridium Difficile Infection Clostridium Difficile Antibiotic Exposure Stool Testing Special Care Unit 
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  1. 1.
    McFarland LV, Mulligan ME, Kwok RY, Stamm WE (1989) Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320:204–210PubMedCrossRefGoogle Scholar
  2. 2.
    Shapiro M, Schwaber MJ, Simhon A, Block C, Roval V, Ferderber N (2000) Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital. Eur J Clin Microbiol Infect Dis 19:9–15CrossRefGoogle Scholar
  3. 3.
    Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN (1992) Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 166:561–567PubMedGoogle Scholar
  4. 4.
    Gorschlüter M, Glasmacher A, Hahn C, Schakowski F, Marklein G, Sauerbruch T, Ziske C, Molitor E, Schmidt-Wolf IGH (2003) Clostridium difficile infection in patients with neutropenia. Clin Infect Dis 33:786–791CrossRefGoogle Scholar
  5. 5.
    Dettenkofer M, Ebner W, Bertz H, Babikir R, Finke J, Frank U, Rüden H, Daschner FD (2003) Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transpl 31:795–801CrossRefGoogle Scholar
  6. 6.
    Husain A, Aptaker L, Spriggs DR, Barakat RR (1998) Gastrointestinal toxicity and Clostridium difficile diarrhea in patients treated with paclitaxel containing chemotherapy regimens. Gynecol Oncol 71:104–107PubMedCrossRefGoogle Scholar
  7. 7.
    Emoto M, Kawarabayashi T, Hachisuga T, Eguchi F, Shirakawa K (1996) Clostridium difficile colitis associated with cisplatin-based chemotherapy in ovarian cancer patients. Gynecol Oncol 61:369–372PubMedCrossRefGoogle Scholar
  8. 8.
    Hornbuckle K, Chak A, Lazarus HM, Cooper GS, Sparano J, Kutteh LA, Gucalp R, Carlisle PS, Parker P, Salata RA (1998) Determination and validation of a predictive model for Clostridium difficile diarrhea in hospitalized oncology patients. Ann Oncol 9:307–311PubMedCrossRefGoogle Scholar
  9. 9.
    Palmore TN, Sohn S, Malak SF, Eagan J, Sepkowitz KA (2005) Risk factors for acquisition of Clostridium difficile-associated diarrhea among outpatients at a cancer hospital. Infect Cont Hosp Epidem 26:680–684CrossRefGoogle Scholar
  10. 10.
    Sohn S, Climo M, Diekema D, Fraser V, Herwaldt L, Marino S, Noskin G, Perl T, Song X, Tokars J, Warren D, Wong E, Yokoe DS, Zembower T, Sepkowitz KA (2005) Varying rates of Clostridium difficile-associated diarrhea at prevention epicenter hospitals. Infect Cont Hosp Epidem 26:676–679CrossRefGoogle Scholar
  11. 11.
    Blot E, Escande MC, Besson D, Barbut F, Granpeix C, Asselain B, Falcou MC, Pouillart P (2003) Outbreak of Clostridium difficile-related diarrhea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 53:187–192PubMedCrossRefGoogle Scholar
  12. 12.
    Turgeon DK, Novicki TJ, Quick J, Carlson L, Miller P, Ulness B, Cent A, Ashley R, Larson A, Coyle M, Limaye AP, Cookson BT, Fritsche TR (2003) Six rapid tests for direct detection of Clostridium difficile and its toxins in fecal samples compared with the fibroblast cytotoxicity assay. J Clin Microbiol 41:667–670PubMedCrossRefGoogle Scholar
  13. 13.
    Nelson DE, Auerbach SB, Baltch AL, Desjardin E, Beck-Sague C, Rheal C, Smith RP, Jarvis WR (1994) Epidemic Clostridium difficile-associated diarrhoea: role of second and third generation cephalosporins. Infect Cont Hosp Epidem 15:88–94CrossRefGoogle Scholar
  14. 14.
    Buchner AM, Sonnenberg A (2002) Epidemiology of Clostridium difficile infection in a large population of hospitalized US military veterans. Digest Dis Sci 47:201–207PubMedCrossRefGoogle Scholar
  15. 15.
    Rosenberg SA, White DE, Kammula US (1998) Trends in the safety of high dose bolus interleukin-2 administration in patients with metastatic cancer. Cancer 83:797–805PubMedCrossRefGoogle Scholar
  16. 16.
    Daubener W et al (1988) Clostridium difficile toxins A and B inhibit human immune responses in vitro. Infect Immune 56:1107–1112Google Scholar
  17. 17.
    Guyot A, Barrett SP (2001) What is an appropriate control group to identify risk factors for Clostridium difficile-associated diarrhoea? J Antimicrob Chemother 48:747–748PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Section of General Internal Medicine, Department of MedicineDartmouth-Hitchcock Medical CenterLebanonUSA
  2. 2.Section of Infectious Disease and International Health, Department of MedicineDartmouth-Hitchcock Medical CenterLebanonUSA

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