Korean J Gastroenterol.  2010 Mar;55(3):169-174. 10.4166/kjg.2010.55.3.169.

Change of Clostridium difficile Colitis during Recent 10 Years in Korea

• Lee YJ
• Choi MG
• Lim CH
• Jung WR
• Cho HS
• Sung HY
• Nam KW
• Chang JH
• Cho YK
• Park JM
• Kim SW
• Chung IS

• KMID: 1775898
• DOI: http://doi.org/10.4166/kjg.2010.55.3.169

Abstract

BACKGROUND/AIMS
Our clinical experience and recent published literatures suggest that Clostridium difficile colitis (CDC) has become more common and potentially more pathogenic in recent years. The aim of study was to evaluate changes in the epidemiological features of CDC in hospitalized patients in Korea.
METHODS
We retrospectively reviewed all patients of CDC diagnosed at Kangnam St. Mary Hospital from 1998 to 2007. CDC was defined as having a positive C. difficile cytotoxicity assay, or endoscopic or pathologic evidence of CDC.
RESULTS
A total of 189 cases (male 73, female 116, mean age 63.3 years) of CDC were diagnosed during the study period. The prevalence of CDC increased from 1.9/10,000 patient admissions in 1998-1999 to 8.82/10,000 patient admissions in 2006-2007. One hundred sixty three indication for cases (86.2%) of patients identified a prior use of antibiotics in the 2 months preceding diagnosis. The most common antibiotic use was prophylactic use during perioperational period (33.3%) followed by pneumonia (23.3%). The overall response rate to initial antibiotics was 82.7%. One hundred seventy two (91%) patients were initially treated with metronidazole. The response rate was 84.3%. All patients with initial failure to metronidazole were successfully treated by vancomycin. The response rate of vancomycin as first treatment was 80%. Three deaths were associated with CDC despite the use of combination of metronidazole and vancomycin.
CONCLUSIONS
The prevalence of CDC in hospitalized patients in Korea significantly increased from 1998 to 2007.

Keyword

Clostridium difficile; Clostridium difficile colitis; Pseudomembranous colitis

MeSH Terms

Aged
Anti-Bacterial Agents/therapeutic use
*Clostridium difficile
Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*epidemiology
Female
Humans
Male
Metronidazole/therapeutic use
Middle Aged
Republic of Korea
Retrospective Studies
Vancomycin/therapeutic use

Figure

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  Fig. 1. Biennial incidence of C. difficile colitis in Kangnam St. Mary Hospital, 1998-2007.

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  Fig. 2. Clinical course of C. difficile colitis and response to antibiotics.

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