title: Length of vancomycin administration for treatment of clostridium difficile-associated diarrhea may depend on presentation of colonic ulcer.
abstract: OBJECTIVE
  Clostridium difficile-associated diarrhea (CDAD) is a notorious iatrogenic infection with typical endoscopic features consisting of pseudomembranes (PMs). Concomitant colonic ulcers are sometimes endoscopically detected. We hypothesized that length of vancomycin (VCM) administration for treatment depends on presentation of colonic ulcer.
  
  
  METHODS
  We investigated retrospectively endoscopic findings and total number of days of vancomycin administration for patients who showed evidence of C. difficile toxin A or PMs at our hospitals. We excluded CDAD cases with inflammatory bowel disease.
  
  
  RESULTS
  Sixteen patients were diagnosed as having CDAD. All patients receiving endoscopic examination presented PMs. Two cases had PMs in the transverse and small intestine. The patients with ulcers needed 5-28 days of administration of VCM, while all those without ulcers except one were cured within seven days.
  
  
  CONCLUSIONS
  Our results suggest that ulcer may be a factor of poor prognosis, and we recommend endoscopic examination for all patients with CDAD for identification of poor prognostic groups.
authors: Department of Hematology and Oncology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
authors: Mihoko
authors: M
authors: Yamashita
authors: Kenichi
authors: K
authors: Nomura
authors: Yoshiko
authors: Y
authors: Fujimoto
authors: Yasutaka
authors: Y
authors: Morimoto
authors: Muneo
authors: M
authors: Ohshiro
authors: Yasuhiko
authors: Y
authors: Tsutsumi
authors: Tsutomu
authors: T
authors: Kobayashi
authors: Hiroto
authors: H
authors: Kaneko
authors: Satoru
authors: S
authors: Yasuhawa
authors: Akio
authors: A
authors: Yanagisawa
authors: Yoshikawa
authors: Y
authors: Toshikazu
authors: Taniwaki
authors: T
authors: Masafumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003108:Colonic Diseases / Q000188:drug therapy* / Q000382:microbiology*; D003967:Diarrhea / Q000188:drug therapy*; D016099:Endoscopy, Gastrointestinal; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000188:drug therapy* / Q000382:microbiology*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin