Clostridium difficile diarrhea in critically ill burned patients
B. J. Grube, D. M. Heimbach and J. A. Marvin
We followed up 112 patients in the University of Washington Burn Center,
Seattle, for the development of Clostridium difficile diarrhea. Diarrhea
developed in 20 patients with a mean burn size of 42%, mean age of 38
years, and 49 mean total antibiotic days, for an incidence of 17%. Eleven
patients had 16 episodes of nonspecific diarrhea. Nine patients had 11
episodes of C difficile-positive diarrhea and 15 episodes of nonspecific
diarrhea for an incidence of 45% of all patients with diarrhea. There were
no differences in patient age, burn size, or length of stay between the
groups. When the 31 episodes of nonspecific diarrhea were compared with the
11 episodes of C difficile diarrhea, there were no differences between the
groups in temperature, albumin levels, or total number of antibiotic days
preceding the episodes of diarrhea. The only significant finding that
differed between the two types of diarrhea was the white blood cell count
on the day of diagnosis. The nonspecific diarrhea was self-limited,
requiring antimotility agents in 45% of the episodes. The C difficile
diarrhea responded promptly to vancomycin hydrochloride, with resolution of
symptoms in an average of 3.3 days. There were two recurrences, and both
responded to a second course of vancomycin.
