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A 5-year retrospective review of experience with Clostridium difficile-associated diarrhea.
MedLine Citation:
PMID:  22594138     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
The incidence and virulence of Clostridium difficile-associated diarrhea (CDAD) has increased dramatically from the mid 1990s to the mid 2000s. This research assessed recent CDAD patterns at a major military medical center from 2005 to 2009, by retrospectively reviewing clinical data of each CDAD case identified using the center's electronic medical record system. Two hundred and thirty-two cases were identified. There was a stable incidence rate for both inpatient (2.6-4.3/1000) and outpatient (0.02-0.04/1000) infections. Overall mortality rate was 9%. Among inpatient cases, 49% were considered to be severe, with an associated mortality of 19%. Only 12% (9/77) of severe cases were treated initially with oral vancomycin, with the majority (8/9) treated in 2009. Hospitalization was a risk factor in 71% of cases, with 29% community-acquired. Other risk factors included recent antibiotic usage (83%) and proton-pump inhibitor use (60%), with 8% having no risk factors. Most cases were initially treated with metronidazole, which was associated with a 14% (27/188) recurrence rate versus 9% (2/22) treated with vancomycin (p > 0.05). In contrast to earlier reports, our center has experienced a low and stable rate of CDAD since 2005. Severe CDAD is common and associated with significant mortality.
Authors:
Steven Armbruster; Lawrence Goldkind
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Military medicine     Volume:  177     ISSN:  0026-4075     ISO Abbreviation:  Mil Med     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-05-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2984771R     Medline TA:  Mil Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  456-9     Citation Subset:  IM    
Affiliation:
Gastroenterology Department, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
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