title: A 5-year retrospective review of experience with Clostridium difficile-associated diarrhea.
abstract: The incidence and virulence of Clostridium difficile-associated diarrhea (CDAD) has increased dramatically from the mid 1990s to the mid 2000s. This research assessed recent CDAD patterns at a major military medical center from 2005 to 2009, by retrospectively reviewing clinical data of each CDAD case identified using the center's electronic medical record system. Two hundred and thirty-two cases were identified. There was a stable incidence rate for both inpatient (2.6-4.3/1000) and outpatient (0.02-0.04/1000) infections. Overall mortality rate was 9%. Among inpatient cases, 49% were considered to be severe, with an associated mortality of 19%. Only 12% (9/77) of severe cases were treated initially with oral vancomycin, with the majority (8/9) treated in 2009. Hospitalization was a risk factor in 71% of cases, with 29% community-acquired. Other risk factors included recent antibiotic usage (83%) and proton-pump inhibitor use (60%), with 8% having no risk factors. Most cases were initially treated with metronidazole, which was associated with a 14% (27/188) recurrence rate versus 9% (2/22) treated with vancomycin (p > 0.05). In contrast to earlier reports, our center has experienced a low and stable rate of CDAD since 2005. Severe CDAD is common and associated with significant mortality.
authors.affiliation: Gastroenterology Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Armbruster
authors.forename: Lawrence
authors.initials: L
authors.lastname: Goldkind
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D016347:Medical Records Systems, Computerized; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D008887:Military Medicine; D010045:Outpatients / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014640:Vancomycin / Q000627:therapeutic use; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin