Fluoroquinolone Use and Risk Factors for Clostridium difficile-Associated Disease within a Veterans Administration Health Care System

摘要: Background. Prompted by the changing profile of Clostridium difficile infection and impact formulary policies in hospitals, we performed this study when an increase incidence C. difficile–associated disease was noted at our health care center (Veterans Administration Puget Sound Health Care System, Seattle, Washington). Methods. A retrospective, matched case-control patients presenting to Veterans Washington during 2004 performed. Conditional logistic analysis determined risk factors for case patients, defined as individuals with diarrhea test results (i.e., culture or toxin assay results) positive difficile, control subjects, negative difficile. Results. 29.2 cases per 10,000 inpatient-days. The that paralleled increased gatifloxacin use not attributable antimicrobial but a reflection seasonal variation rate disease. Multivariate controlling time which performed, age patient, ward, source acquisition (community-acquired vs. nosocomial disease) found 6 significant diarrhea: receipt clindamycin (adjusted odds ratio [aOR], 29.9; 95% confidence interval [CI], 3.58–249.4), penicillin (aOR, 4.1; CI, 1.2–13.9), having lower intestinal condition 2.8; 1.3– 6.1), total number antibiotics received 1.4; 1.1–1.7), prior hospital admissions 1.3; 1.1–1.6), comorbid conditions 1.1–1.5). Conclusions. change fluoroquinolones; instead, within expected variations difficile– associated Recognition community-acquired may help identify additional Early diagnosis treatment shorten duration stays reduce outbreaks readmissions, mortality, other consequences infection.