A 5-year retrospective review of experience with Clostridium difficile-associated diarrhea

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  • L. G
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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.

Author-supplied keywords

  • *Clostridium difficile
  • *antiinfective agent/dt [Drug Therapy]
  • *diarrhea/dt [Drug Therapy]
  • *pseudomembranous colitis/di [Diagnosis]
  • *pseudomembranous colitis/dt [Drug Therapy]
  • United States/ep [Epidemiology]
  • article
  • comparative study
  • cross infection
  • electronic medical record
  • female
  • hospital patient
  • human
  • incidence
  • isolation and purification
  • male
  • metronidazole/dt [Drug Therapy]
  • microbiology
  • middle aged
  • military medicine
  • mortality
  • outpatient
  • public hospital
  • recurrent disease
  • retrospective study
  • risk factor
  • statistics
  • survival rate
  • treatment outcome
  • vancomycin/dt [Drug Therapy]
  • veteran

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Authors

  • Armbruster S.

  • Goldkind L.

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