Clinical manifestations and outcome of Pseudomembranous colitis in an elderly population in Israel.
BACKGROUND
Pseudomembranous colitis is a well-recognized cause of diarrhea in patients receiving antibiotics and has significant consequences in terms of morbidity, mortality and cost. Clostridium difficile infection is the single most important infectious cause of PMC. PMC is frequently nosocomial, with an increased risk of spread among institutionalized patients, both in hospitals and nursing homes.


OBJECTIVE
To investigate the demographic, clinical and laboratory characteristics of PMC patients in an Israeli elderly population.


METHODS
We studied 72 hospitalized patients with endoscopically proven PMC. The medical records of all patients including clinical history and laboratory data were reviewed, such as: age, pre-hospitalization status (dependency or not, in the community as compared to the nursing home), background medical history, presenting symptoms, antibiotic history, physical examination on admission, hematologic and biochemical parameters, treatment, duration of hospitalization, complications, mortality, and recurrence of disease.


RESULTS
Of the 72 patients (34 males and 38 females, mean age 77 years) 47% were nursing home residents. Pre-hospitalization antibiotic treatment was given to 91.4% for infections of the upper respiratory tract (45%) and urinary tract (45%). The most common antibiotics were cephalosporin (64%), penicillins (42%) and quinolones (28%). Sixty-four percent of the patients were treated with more than one antibiotic, 26% of patients received anti-acid therapy and 36% had been fed with a nasogastric tube. On admission, leukocytosis was found in 79% of patients, > 20,000/mm3 in half of them; 60% were anemic, 60% had elevated erythrocyte sedimentation rate, and 78% had hypoalbuminemia. Treatment consisted of metronidazole (41%) or a combination of metronidazole and vancomycin (56%). Overall, 31% of patients recovered without complications, 29% died within 30 days of hospitalization, and 24% were re-hospitalized due to recurrence of PMC.


CONCLUSIONS
The most common antibiotics implicated in PMC are cephalosporin, penicillins and quinolones. The disease is associated with high mortality and recurrence rates.
Moshkowitz
Menachem
M
Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. moshkov7@zahav.net.il
Ben Baruch
Efrat
E
Kline
Zeev
Z
Moshe
Gelber
G
Shimoni
Zvi
Z
Konikoff
Fred
F
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D008795:Metronidazole