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Difference in the Incidence of Clostridium difficile Among Patients Infected With Human Immunodeficiency Virus Admitted to a Public Hospital and a Private Hospital

Published online by Cambridge University Press:  02 January 2015

Joseph J. Pulvirenti ,
Dale N. Gerding ,
Catherine Nathan ,
Irfan Hafiz ,
Tarun Mehra ,
Dayle Marsh ,
Frank Kocka ,
Thomas Rice ,
Staci A. Fischer  and
John Segreti
...Show all authors
Joseph J. Pulvirenti*
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Dale N. Gerding
Affiliation:
VA Chicago Health Care System, Lakeside Division, and the Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
Catherine Nathan
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Irfan Hafiz
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Tarun Mehra
Affiliation:
Lyndon Medical Center, Columbus, Ohio
Dayle Marsh
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Frank Kocka
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Thomas Rice
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
Staci A. Fischer
Affiliation:
Rush Presbyterian St. Luke's Medical Center, Rush Medical College, Chicago, Illinois
John Segreti
Affiliation:
Rush Presbyterian St. Luke's Medical Center, Rush Medical College, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois
*
Division of Infectious Diseases, Cook County Hospital, 1835 West Harrison, Chicago, IL 60612
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Abstract

Objective:

To compare the occurrence of Clostridium difficile among inpatients infected with human immunodeficiency virus (HPV) in two different hospitals.

Design:

Prospective, observational study.

Setting:

Specialized HPV inpatient units.

Patients:

HIV-infected inpatients at Cook County Hospital (CCH) and Rush Presbyterian St. Luke's Medical Center (RPSLMC).

Interventions:

A clinical and epidemiologic assessment of patient risk factors for C. difficile was performed. C. difficile isolates found on stool, rectal, and environmental cultures were typed by pulsed-field gel electrophoresis.

Results:

Twenty-seven percent of patients admitted to CCH versus 4% of patients admitted to RPSLMC had positive cultures for C. difficile (P = .001). At CCH, 14.7% of environmental cultures were positive versus 2.9% at RPSLMC (P = .002). Risk factors for C. difficile acquisition included hospitalization at CCH, more severe HrV, use of acyclovir and H2-blockers, and longer hospital stay. Patients admitted to CCH were taking more antibiotics, had longer hospital stays, and more frequently had a history of C. difficile infection. During the study, two strains (CD1A and CD4) extensively contaminated the CCH environment. However, only CD1A caused an outbreak.

Conclusions:

The C. difficile acquisition rate at CCH was sevenfold higher than that at RPSLMC, and CCH had a more contaminated environment Differences in patient acquisition rates likely reflect a greater prevalence of traditional C. difficile risk factors and a concurrent outbreak at CCH. Although two strains heavily contaminated the environment at CCH, only one caused an outbreak, suggesting that factors other than the environment are important in initiating C. difficile outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 641 - 647
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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