Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: a retrospective analysis.
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Date
2011-03
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Abstract
The spectrum of Clostridium difficile-associated diarrhea (CDAD) is changing. Apart from antibiotic use, other risk factors such as use of proton pump inhibitors (PPI)
and immunosuppressive agents, intensive care unit (ICU) stay
and inflammatory bowel disease are being recognized. We
retrospectively analyzed data on patients whose stool samples
were tested for C. difficile toxin (CDT) by enzyme linked
immunosorbent assay between June 2006 and May 2008.
Demographic and clinical data, and risk factors (antibiotic use,
underlying malignancy, chemotherapy, use of PPI, ICU stay)
were noted. The details of treatment for CDAD, response,
complication and follow up were recorded. Patients whose
stool samples were CDT-positive were grouped as study
subjects and those with negative stool samples were included
in the control group. Of the 99 patients (mean age 46.7 years;
58 men) whose stool samples were tested during this period,
17 (17%) were positive for CDT. As compared with control
subjects (n=82), study subjects were more likely to have
fever, prolonged ICU stay, underlying malignancy, and
exposure to immunosuppressive and chemotherapeutic agents.
On multivariate analysis, exposure to immunosuppressive
agents was the only risk factor associated with CDAD. Fifteen
patients were treated with metronidazole and two with
vancomycin. Two patients did not respond to metronidazole
but responded to vancomycin. No patient developed any
complication. The prevalence of C. difficile toxin in diarrheal
stools sent for C. difficile toxin testing was 17%. Exposure to
immunosuppressive agents was a risk factor for the infection. Metronidazole was effective in a majority of patients.
Description
Keywords
Antibiotic-associated diarrhea, Immunosuppressive agents, Proton pump inhibitors
Citation
Ingle Meghraj, Deshmukh Abhijit, Desai Devendra, Abraham Philip, Joshi Anand, Rodrigues Camilla, Mankeshwar Ranjit. Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: a retrospective analysis. Indian Journal of Gastroenterology. 2011 Mar-Apr; 30(2): 89-93.