Patterns and prognosis ofClostridium difficile colitis |
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Authors: | Boyd C Marts MD PhD Walter E Longo MD Anthony M Vernava III MD Donald J Kennedy MD Gayle L Daniel RN BSN Ivy Jones RN |
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Institution: | (1) Department of Surgery, Section of Colon and Rectal Surgery, St. Louis University School of Medicine, St. Louis, Missouri;(2) Department of Medicine, Division of Infectious Diseases, St. Louis University School of Medicine, St. Louis, Missouri |
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Abstract: | The incidence of
Clostridium difficile
colitis has increased during recent years, presumably because of liberal use of broad-spectrum antibiotic regimens. METHODS: A retrospective review to determine patterns of
C. difficile
colitis development, morbidity, and treatment results was undertaken. During an 18-month period, 90 patients were diagnosed with
C. difficile
colitis by fecal toxin assays. Patient demographics, symptoms, previously administered antibiotic regimens, diagnostic evaluations, treatment modalities, morbidity, and mortality were identified, entered into a computer data base, and analyzed. RESULTS: The mean age was 58 years; males outnumbered females 1.2 1. Among 90 patients, 41 (46 percent) developed
C. difficile
colitis after surgical procedures. Eighty (89 percent) patients received antibiotic therapy before developing
C. difficile
colitis: 35 (44 percent) for documented infections and 45 (56 percent) as empiric or prophylactic therapy. Cephalosporins, penicillins, quinolones, vancomycin, and aminoglycosides were the most frequently administered antibiotic classes prior to
C. difficile
colitis diagnosis. Ten (11 percent) patients developed
C. difficile
colitis without previous antibiotic therapy. Eighty-two (91 percent) patients presented with diarrhea, while eight (9 percent) had fever only. Primary
C. difficile
colitis treatment for both groups included vancomycin (66 percent), metronidazole (24 percent), or both drugs (10 percent). Ten (11 percent) patients received no treatment. No patient developed toxic colitis or megacolon. Colonoscopy was performed in four (4 percent) patients; pseudomembranes were identified in one (25 percent) patient. There was one
C. difficile
colitis recurrence after treatment, but no
C. difficile
colitis-associated morbidity. Mortality (14 patients, 16 percent) was not related to
C. difficile
colitis, but to underlying illness. No difference in patient age, sex, previous antibiotic administration, serum albumin, total days hospitalized, duration of
C. difficile
colitis antibiotic therapy,C. difficile
colitis treatment regimens, or mortality was identified between nonsurgical and surgical patients. The white blood cell count was significantly lower in the nonsurgical group however.Clostridium difficile
colitis developed most commonly after antibiotic administration with symptoms of diarrhea, but did occur without previous antibiotic administration or diarrhea. CONCLUSION: Despite the clinical setting,C. difficile
colitis had no associated morbidity and treatment was highly effective. Mortality was related to underlying medical illness, not
C. difficile
colitis.Read at the meeting of The American Society of Colon and Rectal Surgery, Chicago, Illinois, May 2 to 7, 1993. |
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Keywords: | Clostridium difficile
colitis Diarrhea Immunosuppression |
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