Difference in the Incidence ofClostridium difficileAmong Patients Infected With Human Immunodeficiency Virus Admitted to a Public Hospital and a Private Hospital

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Abstract
Objective: To compare the occurrence ofClostridium difficileamong inpatients infected with human immunodeficiency virus (HPV) in two different hospitals.Design: Prospective, observational study.Setting: Specialized HPV inpatient units.Patients: HIV-infected inpatients at Cook County Hospital (CCH) and Rush Presbyterian St. Luke's Medical Center (RPSLMC).Interventions: A clinical and epidemiologic assessment of patient risk factors forC. difficilewas performed.C. difficileisolates found on stool, rectal, and environmental cultures were typed by pulsed-field gel electrophoresis.Results: Twenty-seven percent of patients admitted to CCH versus 4% of patients admitted to RPSLMC had positive cultures forC. difficile(P= .001). At CCH, 14.7% of environmental cultures were positive versus 2.9% at RPSLMC (P= .002). Risk factors forC. difficileacquisition included hospitalization at CCH, more severe HrV, use of acyclovir and H2-blockers, and longer hospital stay. Patients admitted to CCH were taking more antibiotics, had longer hospital stays, and more frequently had a history ofC. difficileinfection. During the study, two strains (CD1A and CD4) extensively contaminated the CCH environment. However, only CD1A caused an outbreak.Conclusions: TheC. difficileacquisition rate at CCH was sevenfold higher than that at RPSLMC, and CCH had a more contaminated environment Differences in patient acquisition rates likely reflect a greater prevalence of traditionalC. difficilerisk factors and a concurrent outbreak at CCH. Although two strains heavily contaminated the environment at CCH, only one caused an outbreak, suggesting that factors other than the environment are important in initiatingC. difficileoutbreak.

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