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Volume 39, Number 3, June 2006

Prevalence and clinical features of Clostridium difficile-associated diarrhea in a tertiary hospital in northern Taiwan

Meng-Shiuan Hsu, Jann-Tay Wang, Wen-Kuei Huang, Yung-Ching Liu, Shan-Chwen Chang
Department of Internal Medicine, National Taiwan University Hospital, Taipei; Departments of Laboratory Medicine and Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung; School of Medicine, National Yang Ming University, Taipei; and Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

Received: May 14, 2005    Revised: August 1, 2005    Accepted: August 26, 2005   


Corresponding author:

Dr. Shan-Chwen Chang, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung-Shan South Road, Taipei 100, Taiwan E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it



Background and purpose: 

Although the clinical manifestations of and risk factors for Clostridium difficile-associated diarrhea (CDAD) have been extensively investigated in western populations, data from Taiwanese patients are comparatively limited. This study investigated the incidence density of CDAD in Taiwanese patients and also the risk factors and clinical manifestations of CDAD.



From September 21, 2003 to December 21, 2003, patients hospitalized in 2 infection wards and 6 medical intensive care units at National Taiwan University Hospital who were older than 20 years, had a history of antibiotic usage within the prior 6 weeks, and developed diarrhea without another identified etiology were classified as having antibiotic-associated diarrhea (AAD), and were enrolled for further study. The diagnosis of CDAD was established when toxin A of C. difficile was detected in stool.




The incidence density of AAD was 1/100 person-days of antibiotics usage. CDAD accounted for 12.5% of AAD. Fever and abdominal discomfort developed in only less than half of CDAD patients. Pus cell in the stool sample was found in 100 percent of patients with CDAD. Univariate analysis revealed that presence of malignancy and treatment with antifungal agents within the previous 6 weeks were risk factors for CDAD development. In multivariate analysis, use of antifungal agents was the only independent risk factor for CDAD.




The incidence density of CDAD in this study of Taiwanese patients with AAD was 12.5%. Prior usage of antifungal agents was the only independent factor associated with subsequent CDAD development in patients with AAD.



Key words:

Antibacterial agents, Clostridium difficile, diarrhea, prevalence, risk factors, Taiwan



J Microbiol Immunol Infect 2006;39:242-248.