1921
Volume 77, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

The prevalence, incidence, and epidemiologic factors of –associated diarrhea (CDAD) in a Peruvian hospital were studied. We conducted a cross-sectional study in patients > 14 years of age from medical/surgical wards of the Cayetano Heredia National Hospital (Lima, Peru) from September 2005 to May 2006. CDAD was defined in a case of nosocomial diarrhea when toxin A and/or toxin B was detected by enzyme immune assay (EIA) in stools. A total of 4,264 patients were admitted, with 156 (3.7%) developing nosocomial diarrhea. Fifty-five of 156 (35.2%) cases of nosocomial diarrhea were diagnosed as CDAD. The overall incidence per 1,000 admissions was 12.9. Multivariate analysis showed that use of diapers (OR, 3.54; 95% CI, 1.71–7.34; = 0.001) and presence of another patient with CDAD housed in the same room (OR, 2.97; 95% CI, 1.14–7.76; = 0.026) were significantly associated with CDAD. Hospital transmission of commonly occurred, supporting infection-appropriate measures directed toward the reduction of CDAD in low-resource settings.

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References

  1. Farr BM, 2004. Nosocomial gastrointestinal tract infections. Mayhall CG, eds. Hospital Epidemiology and Infection Control. Third edition. Philadelphia, PA: Lippincott Williams & Williams, 351–384.
  2. Kyne L, Hamel MB, Polavaram R, Kelly CP, 2002. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 34 : 346–353. [Google Scholar]
  3. Wilcox MH, Fawley WN, Wigglesworth N, Parnell P, Verity P, Freeman J, 2003. Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile. J Hosp Infect 54 : 109–114. [Google Scholar]
  4. Johnson S, Gerding NG, 1998. Clostridium difficile–associated diarrhea. Clin Infect Dis 26 : 1027–1036. [Google Scholar]
  5. Barbut F, Corthier G, Charpak Y, Cerf M, Monteil H, Fosse T, Trevoux A, De Barbeyrac B, Boussougant Y, Tigaud S, Tytgat F, Sedallian A, Duborgel S, Collignon A, Le Guern ME, Bernasconi P, Petit JC, 1996. Prevalence and pathogenicity of Clostridium difficile in hospitalized patients: a French multi-center study. Arch Intern Med 156 : 1449–1454. [Google Scholar]
  6. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, Simons RL, 2002. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 235 : 363–372. [Google Scholar]
  7. Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, Bourgault AM, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson TJ, Horn R, Rene P, Monczak Y, Dascal A, 2005. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 353 : 2442–2449. [Google Scholar]
  8. Muto CA, Pokrywka M, Shutt K, Mendelsohn AB, Nouri K, Posey K, Roberts T, Croyle K, Krystofiak S, Patel-Brown S, Pasculle AW, Paterson DL, Saul M, Harrison LH, 2005. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 26 : 273–280. [Google Scholar]
  9. Pepin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, Pepin K, Chouinard D, 2004. Clostridium difficile associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 171 : 466–472. [Google Scholar]
  10. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC, 2005. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 366 : 1079–1084. [Google Scholar]
  11. Ferreira CE, Nakano V, Durigon EL, Avila-Campos MJ, 2003. Prevalence of Clostridium spp. and Clostridium difficile in children with acute diarrhea in Sao Paulo city, Brazil. Mem Inst Oswaldo Cruz 98 : 451–454. [Google Scholar]
  12. Pinto LJ, Alcides AP, Ferreira EO, Avelar KE, Sabra A, Domingues RM, Ferreira MC, 2003. Incidence and importance of Clostridium difficile in paediatric diarrhoea in Brazil. J Med Microbiol 52 : 1095–1099. [Google Scholar]
  13. Torres JF, Cedillo R, Sánchez J, Dillman C, Giono S, Muñoz O, 2004. Prevalence of Clostridium difficile and its cytotoxin in infants in Mexico. J Clin Microbiol 20 : 274–275. [Google Scholar]
  14. Dhawan B, Chaudhry R, Sharma N, 1999. Incidence of Clostridium difficile infection: a prospective study in an Indian hospital. J Hosp Infect 43 : 275–280. [Google Scholar]
  15. Fernandez-Canigia L, Nazar J, Arce M, Dadamio J, Smayevsky J, Bianchini H, 2001. Clostridium difficile diarrhea: frequency of detection in a medical center in Buenos Aires, Argentina. Rev Argent Microbiol 33 : 101–107. [Google Scholar]
  16. Herrera P, Cotera A, Fica A, Galdo T, Alvo M, 2003. High incidence and complications of Clostridium difficile diarrhea among patients with renal diseases. Rev Med Chil 131 : 397–403. [Google Scholar]
  17. Sadeghifard N, Salari MH, Grassemi MR, Shieazi MH, Feizabadi MM, Kazemi B, Majdzadeh R, Amin-Harati A, 2005. Prevalence of Clostridium difficile-associated diarrhea in hospitalized patients with nosocomial diarrhea. Iranian J Publ Health 34 : 67–72. [Google Scholar]
  18. Willingham FF, Ticona Chavez E, Taylor DN, Bowen AB, Crane AR, Gottlieb AL, Gayles MK, Grahn KF, Chavez Perez VM, Salas Apolinario I, Gilman RH, 1988. Diarrhea and Clostridium difficile infection in Latin American patients with AIDS. Working Group on AIDS in Peru. Clin Infect Dis 27 : 487–493. [Google Scholar]
  19. Bowen KE, McFarland LV, Greenberg RN, Ramsey MM, Record KE, Svenson J, 1995. Isolation of Clostridium difficile at a universitary hospital: a two-year study. Clin Infect Dis 20 : S261–S262. [Google Scholar]
  20. Cartmill TD, Orr K, Freeman R, Sisson PR, Lightfoot NF, 1992. Nosocomial infection with Clostridium difficile investigated by pyrolysis mass spectrometry. J Med Microbio 37 : 352–356. [Google Scholar]
  21. Olson M, Shanholtzer CJ, Lee JT, Gerding DN, 1994. Ten years of prospective Clostridium difficile diseases surveillance and treatment at the Minneapolis VA Medical Center, 1982–1991. Infect Control Hosp Epidemiol 15 : 371–381. [Google Scholar]
  22. Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN, 1992. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as the source of infection. J Infect Dis 166 : 561–567. [Google Scholar]
  23. Hota B, 2004. 2004. Contamination, disinfection, and cross-colonization: are hospitals surfaces reservoirs for nosocomial infection? Clin Infect Dis 39 : 1182–1189. [Google Scholar]
  24. Wilcox MH, Cunniffe GJ, Trundle C, Redpath C, 1996. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 34 : 23–30. [Google Scholar]
  25. Fekety R, 1997. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol 92 : 739–750. [Google Scholar]
  26. Tedesco FJ, Barton RW, Alpers DH, 1974. Clindamycin-associated colitis. A prospective study. Ann Intern Med 81 : 429–433. [Google Scholar]
  27. Ford-Jones EL, Mindorff CM, Gold E, Petric M, 1990. The incidence of viral-associated diarrhea after admission to pediatric hospital. Am J Epidemiol 131 : 711–718. [Google Scholar]
  28. McFarland LV, Mulligan ME, Kwok RY, Stamm WE, 1989. Nosocomial acquisition of Clostridium difficile. N Engl J Med 320 : 204–210. [Google Scholar]
  29. McFarland LV, Surawickz CM, Stamm WE, 1990. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 162 : 678–684. [Google Scholar]
  30. Lozniewski A, Rabaud C, Dotto E, Weber M, Mory F, 2001. Laboratory diagnosis of Clostridium difficile-associated diarrhea and colitis: usefulness of Premier Cytoclone A+B enzyme immunoassay for combined detection of stool toxins and toxigenic C. difficile strains. J Clin Microbiol 39 : 1996–1998. [Google Scholar]
  31. O’Connor D, Hynes P, Cormican M, Collins E, Corbett-Feeney G, Cassidy M, 2001. Evaluation of methods for detection of toxins in specimens of feces submitted for diagnosis of Clostridium difficile-associated diarrhea. J Clin Microbiol 39 : 2846–2849. [Google Scholar]
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  • Received : 01 Feb 2007
  • Accepted : 09 May 2007

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