title: Clinical manifestations and outcome of Pseudomembranous colitis in an elderly population in Israel.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. moshkov7@zahav.net.il
authors.forename: Menachem
authors.initials: M
authors.lastname: Moshkowitz
authors.forename: Efrat
authors.initials: E
authors.lastname: Ben Baruch
authors.forename: Zeev
authors.initials: Z
authors.lastname: Kline
authors.forename: Gelber
authors.initials: G
authors.lastname: Moshe
authors.forename: Zvi
authors.initials: Z
authors.lastname: Shimoni
authors.forename: Fred
authors.initials: F
authors.lastname: Konikoff
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole