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Clostridium difficile Colitis
An Increasingly Aggressive Iatrogenic Disease?
Arden M. Morris, MD;
Blair A. Jobe, MD;
Mark Stoney, BA;
Brett C. Sheppard, MD;
Clifford W. Deveney, MD;
Karen E. Deveney, MD
Arch Surg. 2002;137:1096-1100.
Hypothesis The diagnosis of Clostridium difficile colitis is increasing in frequency, with worsening patient outcomes.
Design Retrospective cohort study.
Setting University hospital.
Patients One hundred fifty-seven patients diagnosed with C difficile colitis between 1994-2000.
Main Outcome Measures Resolution of disease, operative intervention, and death.
Results Compared with our previous 10-year experience, overall cases of C difficile colitis have risen by more than 30%, and immunocompromised patients comprise a larger proportion of those affected. One third of patients were receiving posttransplantation medication, chemotherapy, or had human immunodeficiency virus. Of these, 2 (4%) of 51 required surgical intervention and 10 (20%) of 51 died. An additional 18.5% of patients had diabetes, renal failure, or both. Of these, 2 (7%) of 30 required surgery and 4 (13%) of 30 died. Only 9.5% of patients had prophylactic perioperative antibiotics as a sole risk factor; 2 (13%) of 15 required surgery and 3 (20%) of 15 died. The overall mortality rate was 15.3%, increased from 3.5% in our previous series. Neither need for surgery nor mortality differed among these patient groups.
Conclusions The frequency of C difficile colitis remains high and seems to be associated with increasing mortality. Among patients with positive C difficile toxin assay results, immunocompromise and delayed diagnosis no longer seem to be associated with higher risk for death. All patients taking antibiotics are at risk and require early recognition and aggressive medical intervention.
From the Robert Wood Johnson Clinical Scholars Program, University of Washington, and the Department of Surgery, Seattle Veterans Affairs Medical Center, Seattle, Wash (Dr Morris); and the Department of Surgery (Drs Jobe, Sheppard, C. Deveney, and K. Deveney) and Medical College (Mr Stoney), Oregon Health and Science University, Portland.
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