title: Clostridium difficile-associated diseases. The clinical courses of 18 fatal cases.
abstract: OBJECTIVE
  Severe cases of Clostridium difficile-associated diseases with sepsis seem to be rare, as are case reports about the pathogen involved and sepsis. Our objective was to investigate the frequency and the clinical courses of severe cases of C. difficile-associated diseases with a fatal outcome in our hospital.
  
  
  METHODS
  Teaching hospital of the University of Kiel (650 beds).
  
  
  METHODS
  We reviewed retrospectively all deceased patients' charts who had prior histological or microbiological evidence of C. difficile-associated diarrhea (CDAD) and revised the available histological specimens of the autopsies.
  
  
  METHODS
  Over a 4-year period (November 1994-October 1998) we diagnosed 304 cases of C. difficile-associated diseases in our hospital.
  
  
  RESULTS
  Eighteen of our cases with C. difficile-associated diseases had a fatal outcome. C. difficile was not likely to be the cause of death in two of the cases. Four of the fatal infections were community-acquired and the reason for admission to the hospital. CDAD is most prevalent in elderly patients with multiple or severe underlying diseases and tends to be overlooked. Sepsis was diagnosed in 15 of our 18 patients with C. difficile-associated diseases.
  
  
  CONCLUSIONS
  Our study shows that severe cases of CDAD or cases with C. difficile-associated sepsis are probably not rare. Routine testing of fecal specimens for the presence of C. difficile toxins should be considered not only in nosocomial gastrointestinal infections but also in community-acquired gastrointestinal infections of elderly people.
authors.affiliation: Pathologisch-Bakteriologisches Institut, Städtisches Krankenhaus Kiel, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Siemann
authors.forename: M
authors.initials: M
authors.lastname: Koch-Dörfler
authors.forename: G
authors.initials: G
authors.lastname: Rabenhorst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003967:Diarrhea / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology*