title: Clostridium difficile infection at a medical center in southern Taiwan: incidence, clinical features and prognosis.
abstract: 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.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chih-Huan
authors.initials: CH
authors.lastname: Chung
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Jing-Jou
authors.initials: JJ
authors.lastname: Yan
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Yuan-Pin
authors.initials: YP
authors.lastname: Hung
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D008795:Metronidazole