title: Recent trends in diagnosis and treatment of Clostridium difficile in a tertiary care facility.
abstract: BACKGROUND
  With the prevalence of antibiotic use, the diagnosis and management of Clostridium difficile disease requires assessment.
  
  
  METHODS
  In a retrospective review, patients with a positive culture, toxin, or both during 1 year were identified. Recent literature was reviewed. Results of culture and toxin, prior antibiotic use, antibiotic treatment history and cost were analyzed.
  
  
  RESULTS
  Of 592 patients tested, 101 were positive; 96 of 101 were available for review. Of those positive tested for both, 45% were positive for toxin and culture. Sixty-two of 96 were treated with antibiotics; metronidazole was used in 90%. Ten of 62 antibiotic treatments were changed (mean 3 days). Ten days of metronidazole is 1/200th the cost of vancomycin.
  
  
  CONCLUSIONS
  In 55% of the positive cases in which culture and toxin were obtained, one test was negative. As metronidazole's efficacy and cost compares favorably with vancomycin, metronidazole is the drug of choice. Any changes made to antibiotic regimens occurred prior to the 6 days recommended in the literature.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: Butterworth
authors.forename: E
authors.initials: E
authors.lastname: Koppert
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.forename: B
authors.initials: B
authors.lastname: Wiggs
authors.forename: J K
authors.initials: JK
authors.lastname: MacFarlane
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology; D001955:British Columbia; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification; D003365:Costs and Cost Analysis; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents