Who are susceptible to pseudomembranous colitis among patients with presumed antibiotic-associated diarrhea?
OBJECTIVE
Pseudomembranous colitis is a severe form of antibiotic-associated diarrhea. However, there have been no reports about the factors that make patients with presumed antibiotic-associated diarrhea susceptible to pseudomembranous colitis. This study was designed to determine the clinical risk factors for pseudomembranous colitis among the patients with presumed antibiotic-associated diarrhea.


METHODS
This was a retrospective study of 150 consecutive patients admitted to our institution between January 2000 and December 2004 with a diagnosis of presumed antibiotic-associated diarrhea. All patients underwent sigmoidoscopy or colonoscopy because of diarrhea after administration of antibiotics. Pseudomembranous colitis was confirmed both endoscopically and histologically. Various clinical parameters were compared between the pseudomembranous colitis group and non-pseudomembranous colitis group.


RESULTS
The mean age of patients was 61 years, and 60 percent (90/150) was female. Pseudomembranous colitis was diagnosed in 53 percent (80/150). On univariate analysis, older than aged 70 years (P = 0.014), antibiotic therapy for more than 15 days (P < 0.0001), hospital stay for more than 20 days (P < 0.0001), number of antibiotics used more than one (P = 0.01), and surgical procedures (P = 0.029) were significant parameters for pseudomembranous colitis. On multivariate analysis, the important clinical risk factors were advanced age (older than aged 70 years; adjusted odds ratio, 2.7; 95 percent confidence interval, 1.208-6.131; P < 0.016) and long hospital stay (more than 20 days; adjusted odds ratio, 5.1; 95 percent confidence interval, 2.1-12.259; P < 0.0001). When both risk factors were present, the positive predictive value of pseudomembranous colitis was 0.86.


CONCLUSIONS
Advanced age and long hospital stay may make patients with presumed antibiotic-associated diarrhea susceptible to pseudomembranous colitis. Therefore, pseudomembranous colitis should be first suspected in cases with presumed antibiotic-associated diarrhea having such risk factors.
Lee
Ki Sung
KS
Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea. mkjang2@medimail.co.kr
Shin
Woon Geon
WG
Jang
Myoung Kuk
MK
Kim
Hyoung Su
HS
Kim
Hee Seon
HS
Park
Chi Jun
CJ
Lee
Ja Young
JY
Kim
Kyung Ho
KH
Park
Joon Young
JY
Lee
Jin Heon
JH
Kim
Hak Yang
HY
Cho
Sung Jin
SJ
Yoo
Jae Young
JY
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001427:Bacterial Toxins / Q000032:analysis; D016360:Clostridioides difficile; D003967:Diarrhea / Q000139:chemically induced; D004198:Disease Susceptibility; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins