title: [Clinical characteristics and changing epidemiology of Clostridium difficile-associated disease (CDAD)].
abstract: OBJECTIVE
  The spectrum of Clostridium difficile-associated disease (CDAD) ranges from mild diarrhea to life-threatening colitis. Recent studies reported an increase in incidence and severity of CDAD and the presence of severe community-acquired CDAD (CA-CDAD). The aims of this study were to investigate the incidence of CA-CDAD and non-antibiotics-associated CDAD, and to compare the clinical characteristics between hospital-acquired (HA) and CA-CDAD.
  
  
  METHODS
  The medical records of 86 patients who were diagnosed as CDAD in Hanyang University Guri Hospital between January 2005 and October 2007 were retrospectively reviewed.
  
  
  RESULTS
  Of the 86 patients (mean age 64 years), 53 patients were women. The most frequently prescribed antibiotics were cephalosporins (67.4%), followed by aminoglycosides (38.4%) and quinolones (14%). Of the 86 patients, the average duration of treatment and recovery time of symptoms were 11.5 days and 4.6 days, respectively. Seven percent of patients experienced relapse treatment. The overall incidence rate of CA-CDAD and non-antibiotics-associated CDAD were 10.5% and 22.1%, respectively. CA-CDAD group had lower rate of antimicrobial exposure whilst showing higher rate of complications compared to HA-CDAD group. Three patients in the CA-CDAD progressed towards a severe complicated clinical course, including septic shock.
  
  
  CONCLUSIONS
  The incidence rate of CA-CDAD and non-antibiotics-associated CDAD were 10.5% and 22.1%, respectively. CA-CDAD tends to have a higher complication rate compared to HA-CDAD. Community clinicians needs to maintain a high level of suspicion for CDAD, whilst coping with the ever evolving epidemiologic change.
authors.affiliation: Department of Internal Medicine and Laboratory Medicine, Hanyang University College of Medicine, Guri Hospital, Guri, Korea.
authors.forename: Tae Jun
authors.initials: TJ
authors.lastname: Byun
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.forename: Sang Bong
authors.initials: SB
authors.lastname: Ahn
authors.forename: Hyun Seok
authors.initials: HS
authors.lastname: Cho
authors.forename: Tae Yeob
authors.initials: TY
authors.lastname: Kim
authors.forename: Chang Soo
authors.initials: CS
authors.lastname: Eun
authors.forename: Yong Cheol
authors.initials: YC
authors.lastname: Jeon
authors.forename: Joo Hyun
authors.initials: JH
authors.lastname: Sohn
authors.forename: Jung Oak
authors.initials: JO
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000032:analysis; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D004768:Enterotoxins / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D002511:Cephalosporins; D004768:Enterotoxins; D015363:Quinolones; C041348:tcdA protein, Clostridium difficile; D008795:Metronidazole