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Volume 48, Number 2, April 2015

Risk factors for Clostridium difficile-associated diarrhea among hospitalized adults with fecal toxigenic C. difficile colonization 

Hsiao-Ju Lin, Yuan-Pin Hung, Hsiu-Chuan Liu, Jen-Chieh Lee, Chih-I Lee, Yi-Hui Wu, Pei-Jane Tsai, Wen-Chien Ko

Received: April 26, 2013    Revised: July 31, 2013    Accepted: August 9, 2013   


Corresponding author:

Wen-Chien Ko,
Corresponding author. Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 70403, Taiwan. 


Background and purpose: 

Patients with toxigenic Clostridium difficile colonization (tCDC) are at risk of developing C. difficile-associated diarrhea (CDAD). However, the risk factors of hospitalized patients with tCDC developing CDAD are not clear 



We conducted an 18-month prospective study at a medical ward in a district hospital in southern Taiwan. Within 48 hours of admission, weekly stool samples from asymptomatic hospitalized patients were obtained to detect fecal CDC. A polymerase chain reaction for tcdB was performed to determine toxigenic isolates. CDAD was diagnosed if the patient had diarrhea and toxigenic C. difficile present in a stool sample. 



A total 483 patients with stool samples were eligible for the study. Eighty-six (17.8%) patients had tCDC after screening, of whom 14 (16.3%) developed CDAD during follow-up. Among those with tCDC, patients with subsequent CDAD were more likely to have diabetes mellitus (p = 0.01) and to have received piperacillin–tazobactam (p = 0.04), or proton-pump inhibitors (PPIs; p = 0.04) than those without developing CDAD. The variables were statistically significant as determined by multivariate analysis. However, the 60-day crude mortality rates among tCDC patients with and without subsequent development of CDAD were similar.



Diabetes mellitus and recent receipt of piperacillin–tazobactam or PPIs are independent risk factors for the development of CDAD among hospitalized patients with tCDC. 


Key words:

Clostridium difficile colonization, Clostridium difficile infection, Risk factors, Piperacillin-tazobactam, Proton-pump inhibitors