Clostridium Difficileassociated diarrhea Epidemiology

C. difficile is the leading cause of nosocomial enteric infection. Notably, the incidence and severity of illness associated with C. difficile has been increasing. C. difficile toxins can be found in the stool of 15% to 25% of patients with antibiotic-associated

diarrhea (AAD) and more than 95% of patients with pseudomembranous colitis. More than 90% of health care-associated Clostridium ¿/////c/Vc-associated diarrhea

(CDAD) occur after or during antimicrobial therapy. Clindamycin, cephalospor-ins, and penicillins are the antibiotics most associated with CDAD, but almost all antimicrobial agents except aminoglycosides have been associated with CDAD.29 Fluoroquinolones are strongly associated with CDAD.30,31 Other risk factors for CDAD include increasing age, severe underlying disease, nonsurgical GI procedures, presence of a nasogastric tube, receipt of antiulcer medications, hospitalization in an intensive care unit (ICU), long duration of hospital stay, long duration of antibiotic,

and receiving multiple antibiotics.

The incidence of community-associated C. difficile infection (defined as occurring

in patients not hospitalized in the year prior to diagnosis) is increasing. In addition to antibiotic use, community-associated C. difficile cases are associated with the use of gastric acid-suppressive agents (e.g., proton pump inhibitors and H2-receptor antagonists).

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