Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital

A prospective survey of the adult inpatient population of an urban tertiary care hospital was conducted to determine factors associated with the devel opment of nosocomial diarrhea and the acquisition of Clostridium difficile- associated disease. During the 3-month survey, 98 patients with nosocomial diarrhea were enrolled, and 38 controls were recruited. The controls were p atients without diarrhea lying in beds adjacent to the affected patients. F actors significantly associated with nosocomial diarrhea were the administr ation of a special diet (P = 0.02) and receipt of a greater number of diffe rent antibiotics (P=0.02). Among the 98 patients with diarrhea, Clostridium difficile toxin B was identified in the stool of 13. Factors found to be a ssociated with the presence of toxin B as compared to other causes of nosoc omial diarrhea were a greater number of individual antibiotics used during hospitalization (P=0.02) and receipt of a cephalosporin (P=0.03) or, more s pecifically, a third-generation cephalosporin (P=0.02). Among patients with nosocomial diarrhea, those who had toxin in their stool had a significantl y higher total antibiotic burden (expressed as antibiotic days) than those with diarrhea due to other causes (P=0.01).