Clostridium difficile infection at a medical center in southern Taiwan: incidence, clinical features and prognosis.
OBJECTIVE
An increase in incidence of Clostridium difficile infection (CDI) among Western countries has been noted in recent years. Epidemiological data of CDI are scarce in Taiwan. This study is intended to depict the clinical features of CDI at a medical center in Southern Taiwan.


METHODS
From January 1, 2007 to March 31, 2008, hospitalized patients with CDI (defined as the presence of gastrointestinal symptoms and fecal C. difficile toxin) were identified. Their medical records were reviewed for further evaluation.


RESULTS
A total of 86 cases of CDI were identified in the study period. The incidence was 42.6 cases per 100,000 patient-days, or 3.4 cases per 1,000 discharges, and was highest in intensive care units (110.6 cases per 100,000 patient-days). Variable incidence rates were noted in different wards, and prevalence was higher in the infectious ward. Diarrhea, fever, and abdominal distension were common in 82 (95.3%), 47 (54.7%), and 29 (33.7%) patients, respectively. Metronidazole was the initial therapeutic regimen for 83 (96.5%) patients. Prolonged diarrhea was noted in 31 (36.4%) patients, especially in those on hemodialysis therapy. Recurrence was noted in 7 (8.1%) patients. Fecal carriage of vancomycin-resistant Enterococcus colonization was found in three patients after therapy for CDI. All-cause mortality rate of patients with CDI at 30 days was 23.3%.


CONCLUSIONS
CDI is increasingly being recognized within the medical departments, and should be considered in hospitalized adults with diarrhea, fever, or abdominal distension alone, or in combination.
Chung
Chih-Huan
CH
Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan.
Wu
Chi-Jung
CJ
Lee
Hsin-Chun
HC
Yan
Jing-Jou
JJ
Chang
Chia-Ming
CM
Lee
Nan-Yao
NY
Chen
Po-Lin
PL
Lee
Ching-Chi
CC
Hung
Yuan-Pin
YP
Ko
Wen-Chien
WC
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000302:isolation & purification; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D003967:Diarrhea / Q000382:microbiology / Q000473:pathology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D005243:Feces / Q000737:chemistry / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D008795:Metronidazole