Clostridium difficile colitis: an increasing hospital-acquired illness.
BACKGROUND
Colitis caused by Clostridium difficile is receiving increased attention as a nosocomial hospital-acquired infection.


METHODS
To determine the incidence of C difficile colitis in our facility and the relative proportion of patients dying from the colitis or requiring colectomy for it, we retrospectively reviewed 201 cases of colitis caused by C difficile from 1984 to 1994.


RESULTS
The incidence of C difficile colitis appears to be sharply increasing and is associated with the use of cephalosporins. Among patients who subsequently developed C difficile colitis, the most frequent indication for antibiotic use was perioperative prophylaxis; surgical patients comprised 55% of the total cases. Surgical intervention was required for 5% of patients with C difficile colitis, with an operative mortality of 30%. The overall mortality was 3.5% and was associated with a delay in diagnosis. The only discriminative factor between patients who died and those who survived was length of time from symptoms to treatment--5.43 days for survivors versus 10.7 days for those who died (P < 0.05).


CONCLUSIONS
Most cases of C difficile colitis seen by surgeons have followed the use of perioperative prophylactic antibiotics. Strict guidelines for using perioperative antibiotics should be observed. Prompt recognition of C difficile colitis and aggressive therapy for it are essential for a favorable outcome.
Jobe
B A
BA
Department of Surgery, Oregon Health Sciences University, Portland, USA.
Grasley
A
A
Deveney
K E
KE
Deveney
C W
CW
Sheppard
B C
BC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002792:Cholestyramine Resin / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D011292:Premedication / Q000009:adverse effects; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D015996:Survival Rate; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D007166:Immunosuppressive Agents; D002792:Cholestyramine Resin; D008795:Metronidazole; D014640:Vancomycin