Clostridium difficile colitis: An increasingly aggressive iatrogenic disease?

Arden M. Morris, Blair A. Jobe, Mark Stoney, Brett Sheppard, Clifford Deveney, Karen Deveney

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1096-1100
Number of pages5
JournalArchives of Surgery
Volume137
Issue number10
StatePublished - Oct 1 2002
Externally publishedYes

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Iatrogenic Disease
Clostridium difficile
Colitis
Mortality
Anti-Bacterial Agents
Delayed Diagnosis
Immunocompromised Host
Renal Insufficiency
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
HIV

ASJC Scopus subject areas

  • Surgery

Cite this

Clostridium difficile colitis : An increasingly aggressive iatrogenic disease? / Morris, Arden M.; Jobe, Blair A.; Stoney, Mark; Sheppard, Brett; Deveney, Clifford; Deveney, Karen.

In: Archives of Surgery, Vol. 137, No. 10, 01.10.2002, p. 1096-1100.

Research output: Contribution to journalArticle

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abstract = "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.",
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