title: Who are susceptible to pseudomembranous colitis among patients with presumed antibiotic-associated diarrhea?
abstract: 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.
authors.affiliation: Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea. mkjang2@medimail.co.kr
authors.forename: Ki Sung
authors.initials: KS
authors.lastname: Lee
authors.forename: Woon Geon
authors.initials: WG
authors.lastname: Shin
authors.forename: Myoung Kuk
authors.initials: MK
authors.lastname: Jang
authors.forename: Hyoung Su
authors.initials: HS
authors.lastname: Kim
authors.forename: Hee Seon
authors.initials: HS
authors.lastname: Kim
authors.forename: Chi Jun
authors.initials: CJ
authors.lastname: Park
authors.forename: Ja Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Kim
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Park
authors.forename: Jin Heon
authors.initials: JH
authors.lastname: Lee
authors.forename: Hak Yang
authors.initials: HY
authors.lastname: Kim
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Cho
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Yoo
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins