Korean J Gastroenterol.  2009 Jul;54(1):13-19. 10.4166/kjg.2009.54.1.13.

Clinical Characteristics and Changing Epidemiology of Clostridium difficile-Associated Disease (CDAD)

• Byun TJ
• Han DS
• Ahn SB
• Cho HS
• Kim TY
• Eun CS
• Jeon YC
• Sohn JH
• Kang JO

• KMID: 1792761
• DOI: http://doi.org/10.4166/kjg.2009.54.1.13

Abstract

BACKGROUND/AIMS
The spectrum of Clostridium difficile-associated disease (CDAD) ranges from mild diarrhea to life-threatening colitis. Recent studies reported an increase in incidence and severity of CDAD and the presence of severe community-acquired CDAD (CA-CDAD). The aims of this study were to investigate the incidence of CA-CDAD and non-antibiotics-associated CDAD, and to compare the clinical characteristics between hospital-acquired (HA) and CA-CDAD. METHODS: The medical records of 86 patients who were diagnosed as CDAD in Hanyang University Guri Hospital between January 2005 and October 2007 were retrospectively reviewed. RESULTS: Of the 86 patients (mean age 64 years), 53 patients were women. The most frequently prescribed antibiotics were cephalosporins (67.4%), followed by aminoglycosides (38.4%) and quinolones (14%). Of the 86 patients, the average duration of treatment and recovery time of symptoms were 11.5 days and 4.6 days, respectively. Seven percent of patients experienced relapse treatment. The overall incidence rate of CA-CDAD and non-antibiotics-associated CDAD were 10.5% and 22.1%, respectively. CA-CDAD group had lower rate of antimicrobial exposure whilst showing higher rate of complications compared to HA-CDAD group. Three patients in the CA-CDAD progressed towards a severe complicated clinical course, including septic shock. CONCLUSIONS: The incidence rate of CA-CDAD and non-antibiotics-associated CDAD were 10.5% and 22.1%, respectively. CA-CDAD tends to have a higher complication rate compared to HA-CDAD. Community clinicians needs to maintain a high level of suspicion for CDAD, whilst coping with the ever evolving epidemiologic change.

Keyword

Clostridium difficile; Clostridium difficile-associated disease (CDAD); Community-acquired C. difficile-associated disease (CA-CDAD)

MeSH Terms

Adult
Aged
Aged, 80 and over
Aminoglycosides/therapeutic use
Anti-Bacterial Agents/therapeutic use
Bacterial Toxins/analysis
Cephalosporins/therapeutic use
*Clostridium difficile
Community-Acquired Infections/epidemiology
Cross Infection/epidemiology
Enterocolitis, Pseudomembranous/*diagnosis/drug therapy/epidemiology
Enterotoxins/analysis
Female
Humans
Male
Metronidazole/therapeutic use
Middle Aged
Quinolones/therapeutic use
Retrospective Studies

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