{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T06:01:16Z","timestamp":1767160876508,"version":"build-2238731810"},"reference-count":13,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"unspecified","delay-in-days":11616,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[1991,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X00085469_abs1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X00085469_abs2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Case-control study with two control groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X00085469_abs3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>University-affiliated urban hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X00085469_abs4\">\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X00085469_abs5\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p= .004, 95% confidence interval [CI]= 1.9, 35), use of neomycin (EOR= 15.6, p=.012, 95% CI=1.7, 92), clindamycin (EOR=15.6, p=.005, 95% CI=1.7, 92), metronidazole (EOR=5.7,p=.02,95%CI= 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p&lt;.00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p&lt; .005).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X00085469_abs6\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1086\/646354","type":"journal-article","created":{"date-parts":[[2009,9,1]],"date-time":"2009-09-01T17:29:49Z","timestamp":1251826189000},"page":"345-348","source":"Crossref","is-referenced-by-count":81,"title":["Risk Factors for the Development of\n                    <i>Clostridium difficile<\/i>\n                    -Associated Diarrhea During a Hospital Outbreak"],"prefix":"10.1017","volume":"12","author":[{"given":"Alain","family":"Thibault","sequence":"first","affiliation":[{"name":"Montreal General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Miller","sequence":"additional","affiliation":[{"name":"Montreal General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Gaese","sequence":"additional","affiliation":[{"name":"Montreal General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,3,21]]},"reference":[{"key":"S0195941700016660_ref007","volume-title":"Modern Epidemiology","author":"Rothman","year":"1986"},{"key":"S0195941700016660_ref005","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198901263200402"},{"key":"S0195941700016660_ref006","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/160.6.1087"},{"key":"S0195941700016660_ref012","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.68.4.820"},{"key":"S0195941700016660_ref003","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-110-4-255"},{"key":"S0195941700016660_ref004","first-page":"644","article-title":"Update on pseudomembranous colitis","volume":"151","author":"Silva","year":"1989","journal-title":"West J Med"},{"key":"S0195941700016660_ref010","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1986.00360130117016"},{"key":"S0195941700016660_ref013","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/6.Supplement_1.S222"},{"key":"S0195941700016660_ref001","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7125(16)31413-4"},{"key":"S0195941700016660_ref002","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.Supplement_2.S243"},{"key":"S0195941700016660_ref011","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/162.3.678"},{"key":"S0195941700016660_ref009","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/151.3.476"},{"key":"S0195941700016660_ref008","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/145.2.269"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X00085469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T03:35:14Z","timestamp":1763004914000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X00085469\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,6]]},"references-count":13,"aliases":["10.2307\/30145209"],"journal-issue":{"issue":"6","published-print":{"date-parts":[[1991,6]]}},"alternative-id":["S0899823X00085469"],"URL":"https:\/\/doi.org\/10.1086\/646354","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,6]]}}}