Epidemiology of Suspected Clostridium difficile- Associated Hospital-Acquired Diarrhea in Hospitalized Patients at Siriraj Hospital
Wilawan Thipmontree MD*, Pattarachai Kiratisin MD**, Sathaporn Manatsathit MD*, Visanu Thamlikitkul MD*
Affiliation : * Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Clostridium difficile-associated disease (CDAD) is an important cause of hospital-acquired diarrhea.
Objective : To determine the prevalence, risk factors, diagnosis, treatments and outcomes of the patients with CDAD in
hospitalized patients at Siriraj Hospital.
Material and Method: The medical records of hospitalized patients aged older than 14 years who developed hospital-
acquired diarrhea and their stool samples were sent for detection of C. difficile toxins from March to June 2008 were
reviewed. Risk factors of CDAD were identified by reviewing medical records of CDAD patients (case group) and patients
who had hospital-acquired diarrhea without C. difficile toxins (control group). The patients in the control group were matched
with the case group in terms of gender and age.
Results : Three hundred and twenty three stool samples obtained from 255 adult hospitalized patients were sent to microbiology
laboratory for detection of C. difficile toxins. The prevalence of CDAD in suspected C. difficile-associated hospital-acquired
diarrhea was 12.3% (95% CI 8.5% to 17.6%). Univariate analysis showed that antibiotic use (> 2 agents), proton pump
inhibitor (PPI) use, hematologic malignancy, receiving chemotherapy or immunosuppressive agents were associated with
CDAD. Multivariate analysis revealed that only antibiotic use (> 2 agents), PPI use and hematologic malignancy were
independent risk factors associated with CDAD. Nasogastric intubation was observed to be associated with CDAD as a
protective factor from both univariate and multivariate analyses. Diagnosis of CDAD in most of the patients was made by a
presence of C. difficile toxin in their stool samples. Response rate to metronidazole was 74.5%. The recurrence rate of CDAD
was 3.2%. The mortality rate due to CDAD was 3.2%.
Conclusion : CDAD is not uncommon in the patients with hospital-acquired diarrhea especially in those who have hematologic
malignancy, receive multiple antibiotics or receive PPI. Metronidazole is an acceptable treatment for CDAD. The recurrence
rate of CDAD and mortality rate due to CDAD are low.
Keywords : Clostrium difficile, Hospital-acquired diarrhea
