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Patterns and prognosis ofClostridium difficile colitis

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Diseases of the Colon & Rectum

Abstract

The incidence ofClostridium difficilecolitis has increased during recent years, presumably because of liberal use of broad-spectrum antibiotic regimens. METHODS: A retrospective review to determine patterns ofC. difficilecolitis development, morbidity, and treatment results was undertaken. During an 18-month period, 90 patients were diagnosed withC. difficilecolitis by fecal toxin assays. Patient demographics, symptoms, previously administered antibiotic regimens, diagnostic evaluations, treatment modalities, morbidity, and mortality were identified, entered into a computer data base, and analyzed. RESULTS: The mean age was 58 years; males outnumbered females 1.2∶1. Among 90 patients, 41 (46 percent) developedC. difficilecolitis after surgical procedures. Eighty (89 percent) patients received antibiotic therapy before develo**C. difficilecolitis: 35 (44 percent) for documented infections and 45 (56 percent) as empiric or prophylactic therapy. Cephalosporins, penicillins, quinolones, vancomycin, and aminoglycosides were the most frequently administered antibiotic classes prior toC. difficilecolitis diagnosis. Ten (11 percent) patients developedC. difficilecolitis without previous antibiotic therapy. Eighty-two (91 percent) patients presented with diarrhea, while eight (9 percent) had fever only. PrimaryC. difficilecolitis treatment for both groups included vancomycin (66 percent), metronidazole (24 percent), or both drugs (10 percent). Ten (11 percent) patients received no treatment. No patient developed toxic colitis or megacolon. Colonoscopy was performed in four (4 percent) patients; pseudomembranes were identified in one (25 percent) patient. There was oneC. difficilecolitis recurrence after treatment, but noC. difficilecolitis-associated morbidity. Mortality (14 patients, 16 percent) was not related toC. difficilecolitis, but to underlying illness. No difference in patient age, sex, previous antibiotic administration, serum albumin, total days hospitalized, duration ofC. difficilecolitis antibiotic therapy,C. difficilecolitis treatment regimens, or mortality was identified between nonsurgical and surgical patients. The white blood cell count was significantly lower in the nonsurgical group however.Clostridium difficilecolitis developed most commonly after antibiotic administration with symptoms of diarrhea, but did occur without previous antibiotic administration or diarrhea. CONCLUSION: Despite the clinical setting,C. difficilecolitis had no associated morbidity and treatment was highly effective. Mortality was related to underlying medical illness, notC. difficilecolitis.

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Authors and Affiliations

  1. Department of Surgery, Section of Colon and Rectal Surgery, St. Louis University School of Medicine, St. Louis, Missouri

    Boyd C. Marts M.D., Ph.D., Walter E. Longo M.D., Anthony M. Vernava III M.D. & Gayle L. Daniel R.N., B.S.N.

  2. Department of Medicine, Division of Infectious Diseases, St. Louis University School of Medicine, St. Louis, Missouri

    Donald J. Kennedy M.D. & Ivy Jones R.N.

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  1. Boyd C. Marts M.D., Ph.D.
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  2. Walter E. Longo M.D.
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  3. Anthony M. Vernava III M.D.
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  4. Donald J. Kennedy M.D.
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  5. Gayle L. Daniel R.N., B.S.N.
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  6. Ivy Jones R.N.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgery, Chicago, Illinois, May 2 to 7, 1993.

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Marts, B.C., Longo, W.E., Vernava, A.M. et al. Patterns and prognosis ofClostridium difficile colitis. Dis Colon Rectum 37, 837–845 (1994). https://doi.org/10.1007/BF02050152

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