A study of Clostridium difficile-associated disease at King Chulalongkorn Memorial Hospital, Thailand.
BACKGROUND
Currently, in established antibiotic era, there is a widespread and increasing use of broad-spectrum antibiotics. Clostridium difficile, one of the troublesome intruders, flourishes when normal gut flora is altered by antibiotics. C. difficile is recognized as a frequent and leading cause of antibiotic-associated diarrhea and colitis. It causes substantial morbidity and mortality in hospitalized patients.


OBJECTIVE
The present study was aimed at determining patient characteristics, clinical features, treatment, and outcomes of C. difficile-associated disease (CDAD) in hospitalized patients at King Chulalongkorn Memorial Hospital, Bangkok, Thailand.


METHODS
From 2002 to 2005, 88 patients with positive latex immunoassay for C. difficile toxin A were identified. Data from medical records of 56 patients were available for analysis.


RESULTS
Of 56 patients, there were 28 males and 28 females, with the mean age of 47.39 years (range: 4 months to 93 years). 50 (89.3%) patients had underlying illnesses with hematological malignancies (14 patients, 25%) and solid tumors (15 patients, 26.8%) being the most common. All patients had a history of antibiotic use including current (17 patients, 30.4%), recent (16 patients, 28.6%), or both current and recent uses (23 patients, 41.1%). Cephalosporins and carbapenems were the two most commonly prescribed antibiotics. 25 (44.6%) patients were receiving either omeprazole or ranitidine. 12 (21.4%) patients had received chemotherapy within two months before CDAD diagnosis. Of 50 stool specimens examined, only 26 (52%) had white or red blood cells. Colonoscopy was performed in only three patients, and pathological findings revealed non-specific colitis. Oral metronidazole, intravenous metronidazole, and vancomycin were prescribed for CDAD treatment in 38 (67.9%), 4 (7.1%), and 2 (3.6%) patients, respectively. 8 (14.3%) patients had no specific treatment, and the offending antibiotic was not discontinued in three of them. An overall initial response rate was 66.7%. 2 patients relapsed after metronidazole treatment.


CONCLUSIONS
The present study is the first in Southeast Asia to describe the decreased initial response rate of metronidazole treatment of CDAD. The reasons for this relatively poor response in the presented patients need to be determined in a future study.
Pupaibool
Jakrapan
J
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Khantipong
Mayuree
M
Suankratay
Chusana
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems; D002511:Cephalosporins; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D008297:Male; D008795:Metronidazole; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome
D015780:Carbapenems; D002511:Cephalosporins; D008795:Metronidazole