Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity

摘要: Background: Recent reports suggest that Clostridium difficile colitis may be evolving into a more severe disease. During the second half of 2002 we noted an increase in number patients with C. -associated diarrhea (CDAD) our institution. We describe cases CDAD at institution over 13-year period and investigate changes illness severity. Methods: undertook retrospective chart review all diagnosed Centre hospitalier universitaire de Sherbrooke from Jan. 1, 1991, to Dec. 31, 2003. Because hospital serves well-defined population Quebec, were also able calculate population-based incidence during this period. abstracted data on individual patient charts pharmacy computer databases. defined as having positive cytotoxicity assay result, or endoscopic histopathological evidence pseudomembranous colitis. A case was considered complicated if one following observed: megacolon, perforation, colectomy, shock requiring vasopressor therapy, death within 30 days after diagnosis. Results: total 1721 study The increased 35.6 per 100 000 1991 156.3 2003; among aged 65 years more, it 102.0 866.5 000. proportion 7.1% (12/169) 1991–1992 18.2% (71/390) 2003 ( p 9 /L greater) elevated creatinine level (200 μmol/L strongly associated adverse outcomes: 2003, 45 (40.9%) 110 high leukocyte count level, both, had 28 (25.5%) died After adjustment for age other confounding factors, initially given oral vancomycin therapy risk progression 79% lower than treated metronidazole (adjusted odds ratio 0.2, 95% confidence interval 0.06–0.8, = 0.02). Interpretation: An epidemic case-fatality rate has important consequences elderly region. Our observational equivalence treatment needs questioned.