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

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.

Risk Factors for Recurrence ofClostridium difficileInfection: Effect of Vancomycin-resistant Enterococci Colonization

“…In this study, 13.1% of patients experienced recurrence within 60 days. This rate is lower than those in other Western studies, but is higher than those in previous Korean reports (1.2%-12%) (7-9). …”

Characterization of Cases of Clostridium difficile Infection (CDI) Presenting at an Emergency Room: Molecular and Clinical Features Differentiate Community-Onset Hospital-Associated and Community-Associated CDI in a Tertiary Care Hospital

“…There is only one report about CA-CDI, but it concluded that CA-CDI comprised 10.5% of all CDI cases in South Korea (2). We found that among 32 CDI patients visiting the ER due to abdominal pain and diarrhea, 59.4% had CA-CDI.…”

Epidemiology and Clinical Characteristics ofClostridium difficileInfection in a Korean Tertiary Hospital

“…According to each study definition, 34.4% of CDI were severe cases, 47.7% of CDI patient complained of 5-7 loose stools/day, and 2.6 to 9.7% of CDI resolved diarrhea without treatment (3, 17). Relapse rate was also variable from 7% to 38.3% (17, 18). Attributable mortality was estimated 0.4%-1.3% in HA-CDI and 14.3% in severe cases (3, 19).…”