Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991.
OBJECTIVE
To understand the epidemiology, risks, and management of Clostridium difficile-associated disease (CDAD) and to establish and evaluate reliable methods of surveillance.


METHODS
Case finding was done by daily ward and laboratory rounds. The criteria for CDAD diagnosis were: at least four unformed stools per day for 2 days and a positive culture or cytotoxin for C difficile, or positive endoscopy or autopsy for pseudomembranes.


METHODS
The surveillance covered all patients from 1982 through 1991 in the 820-bed Minneapolis Veterans Affairs Medical Center.


METHODS
The criteria were met by 908 patients. Medical service patients numbered 488; surgical patients, 420. Frequencies ranged from a high of 149 cases in 1982 to a low of 50 cases in 1989.


RESULTS
Stool specimens were obtained on 898 (99%) of the 908 CDAD patients. Stools were culture-positive in 864 (96%) of 898, cytotoxin-positive in 569 (63%) of 898. Endoscopy was performed on 196 (22%) of the 908 patients, and 80 (41%) of 196 patients had pseudomembranes. Ten (1%) of the 908 patients were diagnosed by endoscopy without a stool specimen, or at autopsy. No treatment was needed for 135 (15%) of the 908 CDAD patients, and 19 (2%) of the 908 died before treatment was started. Oral metronidazole was the treatment for 632 (70%) of 908 patients (1% intolerance, 2% failure, 7% relapse) and oral vancomycin was given to 122 (13%) of 908 patients (1% intolerance, 1% failure, 10% relapse). Twelve patients had pseudomembranous colitis at autopsy, and it was the primary cause of death in 5 (0.6%) of 908.


CONCLUSIONS
CDAD usually responds to oral metronidazole or vancomycin but is nonetheless responsible for a high morbidity and occasional mortality in patients even when the diagnosis and treatment are pursued aggressively.
Olson
M M
MM
Department of Surgery, Veterans Affairs Medical Center, Minneapolis, MN.
Shanholtzer
C J
CJ
Lee
J T
JT
Gerding
D N
DN
D000284:Administration, Oral; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D008910:Minnesota / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D014640:Vancomycin / Q000627:therapeutic use
D008795:Metronidazole; D014640:Vancomycin