title: The management of Clostridium difficile-associated diarrhoea in a community hospital.
abstract: OBJECTIVE
  To review the management of patients with Clostridium difficile-associated diarrhoea (CDAD).
  
  
  METHODS
  A retrospective study was conducted on 26 patients with clinical symptoms of CDAD and positive tests for C difficile toxins A and/or B in stool samples, over a 12- month period. Demographic and clinical data on the patients including use of proton pump inhibitors (PPI), management of CDAD, and compliance with local Infection Prevention and Control Guidelines were examined.
  
  
  RESULTS
  The majority of patients were over 45 years of age (24/26, 92.4%) and 42% (11/26) were over 80 years of age. At least 50% (13/26) of the patients had acquired CDAD in hospital, 15% (4/26) were community acquired and symptomatic at admission while the onset of diarrhoea following admission to hospital was not documented in 35% (9/26). Three (11%) patients had used PPI. Fifteen per cent (4/26) of patients had no history of previous antibiotic therapy; 40% (10/26) were treated with a cephalosporin, fluoroquinolone or a combination of at least two different classes of antibiotics; one (3%) patient was on augmentin and the antibiotic regime used was not documented in 42% (11/26) who also had previous antibiotic therapy. The conditions for which antibiotics were prescribed could not be ascertained in 58% (15/26) but among the remaining cases antibiotics had been prescribed for urinary tract infection, wound respiratory tract infections and sepsis. Metronidazole (18/26, 70%) was the preferred drug of choice for first line therapy in patients with CDAD. None of the patients in the study received the recommended 10 to 14 days of antimicrobial therapy for CDAD. Recurrent CDAD was observed in 40% of those who were treated with metronidazole. The study also showed that there was timely reporting of laboratory results and good compliance with the hospital Infection Prevention and Control Guidelines.
  
  
  CONCLUSIONS
  The findings of this study can be used as a process improvement measure in the management of patients with CDAD.
authors.affiliation: Department of Quality and Risk, King Edward VII Memorial Hospital, Paget, Bermuda.
authors.forename: K
authors.initials: K
authors.lastname: Tomkins
authors.forename: J
authors.initials: J
authors.lastname: Raynor
authors.forename: L
authors.initials: L
authors.lastname: Rothwell
authors.forename: J
authors.initials: J
authors.lastname: DeSilva
authors.forename: C
authors.initials: C
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D003428:Cross Infection / Q000517:prevention & control*; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D019983:Guideline Adherence; D006764:Hospitals, Community; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents