Clinical characteristics of Clostridium difficile infection in hospitalized patients with antibiotic-associated diarrhea in a university hospital in China

  • F. F. Zhou
  • S. Wu
  • J. D. Klena
  • H. H. HuangEmail author


The purpose of this study was to identify clinical characteristics of Clostridium difficile infection (CDI) in patients with antibiotic-associated diarrhea (AAD). A prospective study was conducted among patients hospitalized in Fudan University Hospital Huashan from August 1, 2012 to July 31, 2013. Toxigenic C. difficile isolates were characterized by PCR ribotyping and multilocus sequence typing. AAD developed in 1.0 % (206/20437) of the antibiotic-treated hospitalized patients and toxigenic C. difficile was isolated from 30.6 % (63/206) of patients with AAD. The frequency of AAD was highest in the intensive care unit (10.7 %); however the proportion of CDI in AAD was highest in the Geriatric Unit (38 %). AAD ranged in severity from mild to moderate. One case with pseudomembranous colitis was identified. Use of carbapenems was found to significantly increase the risk of CDI (OR, 2.31; 95 % CI, 1.22–4.38; p = 0.011). Patient demographics, presumed risk factors, clinical manifestations and laboratory findings revealed no significant difference between patients with CDI and non-C. difficile AAD. Over 90 % of the patients with CDI or non-C. difficile AAD were cured. Two patients had CDI recurrence. Ribotype H was the dominant (18.8 %) genotype, followed by ribotype 012 and ribotype 017. C. difficile plays a significant role in AAD in our setting in China. Because the severity of diarrhea ranges from mild to moderate, it is difficult for Chinese clinicians to identify CDI from AAD patients, therefore CDI should be included in the routine differential diagnoses for hospitalized patients presenting with AAD.


Berberine Multilocus Sequence Typing Moderate Diarrhea Diarrhea Onset Presume Risk Factor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by a grant from the National Natural Science Foundation of China (no. 30973594 and no. 81101292) and Shanghai Pujiang Programme (no. 10PJ1401800). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflict of interest

None declared.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • F. F. Zhou
    • 1
  • S. Wu
    • 1
  • J. D. Klena
    • 2
  • H. H. Huang
    • 1
    Email author
  1. 1.Institute of Antibiotics, Huashan HospitalFudan UniversityShanghaiChina
  2. 2.Global Disease Detection Branch, Division of Global Health ProtectionCenter for Global Health, Centers for Disease Control and PreventionAtlantaUSA

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