Clinical Characteristics Of Clostridium Difficile-associated Diarrhea

Backgroud and ObjectivesClostridium difficile-associated diarrhea(CDAD)is a more severe form of the antibiotic-associated diarrhea(AAD).The incidence of CDAD in hospital is recently increased worldly with accompanied by a increase in the disease severity and mortality.However, there is a short of the data about CDAD in China, we prospectively determine the incidence of CDAD in our hospital and risk factors associated with the disease occurring in order to early prevent,diagnosis and treatment of CDAD.MethodsThe inpatients with diarrhea after administration of antibiotic at least for 3 days were prospectively investigated with a questionnaire in 2008.The fecal specimen were tested for C.difficle toxin A and B using enzyme-linked fluorescent assay to confirm C.difficle infection.For each CDAD case,3 controls without diarrhea after antibiotics for at least 3 dayds were randomizedly selected from the same department with similar conditions to matched on age(±5 years) and sex during the same period. All analysis including Logistic regression was performed using SPSS statistical software version 17.0, and p<0.05 was considered significant.Results1. Forty-four patients(21.8%) with CDAD was diagnosed from 202 AAD patients during the 6 months study period, of which 39 patiens (88.6%) has get a clinical cure treated with vancomycin with and without metronidazole. No patients died of C.difficle infection.2. The clinical manifestations of patients with CDAD were different from those of AAD. The CDAD patients reported diarrhea by watery stool from 4 to 20 bowel movement per day that were associateg with mucous stool,bloody purulent stool or occasional pseudomembranes. The diarrhoea lasts about 10 days.Some patients have abdominal pain or fever. The following variable in patient with age over 60 years were significantly different from middle-aged group: presence of nasogastic tube-feeding,severe chronic diseases,high APACHEⅡscore,long duration of diarrhea,higher serum C-reaction protein(CRP) levels,and lower serum albumine levels.3. Comparing with AAD, the patiens with CDAD showed a significant association with a higher APACHEⅡscore,longer duration of hospital stay and of antibiotic use,higher level of serum C-reaction protein,and lower level of serum albumine,severe comorbidity ,while they had not been administered with metronidazol or vancomycin before diarrhoea.Logistic regression showed that APACHEⅡscores,multiple comorbidity ,high level of CRP and lower level of albumine were the relative risk factors associated with CDAD, while using metronidazole or vancomycin was the protecting factors.4. When compared with the controls, Logistic regression of multivariate identified the relative risk factors for CDAD as follow: nasogastric tube-feeding, multiple comorbidity ,higher APACHEⅡscore, high level of serum CRP,receiving multiple antibiotics,using the third-generation cephalosporins(P<0.05). Using metronidazole or vancomycin are the protecting factors.Conclusion1. The patients with CDAD accounts for 21.8 % of the AAD patients during the 6 months period, and the most patiens has a clinical cure treated with vancomycin with and without metronidazole.2. Between CDAD and AAD patients,there are markedly different in APACHEⅡscores, number of comorbidity,serum level of C-reaction protein and albumine. 3. Nasogastric tube-feeding, multiple comorbidity ,higher APACHEⅡscore, high level of serum CRP,receiving multiple antibiotics,using the third- generation cephalosporins are risk factors associated with CDAD,while Using metronidazole or vancomycin are the factors protecting patients from CDAD.