Length of vancomycin administration for treatment of clostridium difficile-associated diarrhea may depend on presentation of colonic ulcer.
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.
Yamashita
Mihoko
M
Department of Hematology and Oncology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
Nomura
Kenichi
K
Fujimoto
Yoshiko
Y
Morimoto
Yasutaka
Y
Ohshiro
Muneo
M
Tsutsumi
Yasuhiko
Y
Kobayashi
Tsutomu
T
Kaneko
Hiroto
H
Yasuhawa
Satoru
S
Yanagisawa
Akio
A
Toshikazu
Yoshikawa
Y
Masafumi
Taniwaki
T
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*
D000900:Anti-Bacterial Agents; D014640:Vancomycin