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Predicting Clostridium difficile Toxin in Hospitalized Patients With Antibiotic-Associated Diarrhea

Published online by Cambridge University Press:  02 January 2015

Nir Peled ,
Silvio Pitlik ,
Zmira Samra ,
Arkadi Kazakov ,
Yoram Bloch  and
Jihad Bishara
Nir Peled
Affiliation:
Institute of Pulmonology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Silvio Pitlik
Affiliation:
Department of Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Zmira Samra
Affiliation:
Laboratory of Clinical Microbiology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Arkadi Kazakov
Affiliation:
Department of Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Yoram Bloch
Affiliation:
Recanati Center for Research and Medicine, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Jihad Bishara*
Affiliation:
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa 49100, Israel ([email protected])
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Abstract

Objective.

Clostridium difficile infection is implicated in 20%-30% of cases of antibiotic-associated diarrhea. Studying hospitalized patients who received antibiotic therapy and developed diarrhea, our objective was to compare the clinical characteristics of patients who developed C. difficile–associated diarrhea (CDAD) with those of patients with a negative result of a stool assay for C. difficile toxin.

Methods.

A prospective study was done with a cohort of 217 hospitalized patients who had received antibiotics and developed diarrhea. Patients with CDAD were defined as patients who had diarrhea and a positive result for C. difficile toxin A/B by an enzyme immunoassay of stool. The variables that yielded a significant difference on univariate analysis between patients with a positive assay result and patients with a negative assay result were entered into a logistic regression model for prediction of C. difficile toxin.

Setting.

A 900-bed tertiary care medical center.

Results.

Of 217 patients, 52 (24%) had a positive result of assay for C. difficile toxin A/B in their stool. The logistic regression model included impaired functional capacity, watery diarrhea, use of a proton pump inhibitor, use of a histamine receptor blocker, leukocytosis, and hypoalbuminemia. The area under the receiver operating characteristic curve for the model as a predictor of a positive result for the stool toxin assay was 0.896 (95% confidence interval, 0.661-1.000; P<.001), with 95% specificity and 68% sensitivity.

Conclusions.

Our results may help clinicians to predict the risk of CDAD in hospitalized patients with antibiotic-associated diarrhea, to guide careful, specific empirical therapy, and to direct early attention to infection control issues.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 377 - 381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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