Risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients: a case-control study--sucralfate ingestion is not a negative risk factor.

OBJECTIVES: To assess risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients, and to test the hypothesis that sucralfate ingestion is associated with nondetection of C difficile cytotoxin in stool specimens. DESIGN: A retrospective case-control study of hospitalized adult patients who had stool specimens assayed for C difficile cytotoxin. For each patient who had positive C difficile cytotoxin, a patient who had negative C difficile cytotoxin was used as a control. The study period was January to December 1993. SETTING: A community teaching hospital affiliated with a medical school in northeastern Ohio. RESULTS: There were 91 case patients and 91 control patients. Cephalosporin exposure was identified as a risk factor in patients with C difficile diarrhea. The number of patients who had sucralfate ingestion was comparable in both groups of patients. CONCLUSIONS: Administration of cephalosporins was identified as a risk factor in patients with C difficile diarrhea. We were not able to confirm a recent report of the association between ingestion of sucralfate and nondetection of C difficile cytotoxin in stool specimens. Our findings suggest that sucralfate ingestion is not associated with nondetection of C difficile cytotoxin in stool specimens. Assay of C difficile cytotoxin in stool specimens remains a valid method of diagnosing C difficile diarrhea, even in patients who ingest sucralfate (Infect Control Hosp Epidemiol 1996;17:232-235).