Johal, S.S.; Hammond, J.; Mahida, Y.R.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA92
Academic Journal
CDAD is usually considered to be a problem that develops in patients following hospitalisation for another condition that requires administration of antibiotics. Little is known about patients that require admission to hospital following the onset of CDAD in the community. We have compared patients that developed CDAD following admission to hospital with those in whom the diarrhoea started in the community. Method: Patients admitted to hospital or developing diarrhoea as inpatients were studied. CDAD was diagnosed in the presence of diarrhoea (> 3 liquid motions in 24 h) and either positive stool C difficile cytotoxin test or pseudomembranes were seen at sigmoidoscopy and the diarrhoea responded to vancomycin or metronidazole. Results: Over a period of 30 months, 136 patients with CDAD (50 male and 86 female) of median age 82 year (range 24 - 97 year) were studied, of which 131 (96%) had taken broad spectrum antibiotic(s) prior to the onset of diarrhoea. In 38 (28%) diarrhoea developed in the community and in 98 (72%) diarrhoea developed while inpatient. Of the patients admitted with diarrhoea, 33 (86.8%) had been hospitalised over the preceding 12 months compared with 56 (57.1%) that developed diarrhoea as inpatient (p < 0.001). Prior to treatment, patients who developed diarrhoea in the community had a higher daily stool frequency (7.2 (±0.8) vs 4.6 (+0.2), p < 0.001) and shorter period of hospitalisation (23 (±3) vs 49 (±4) days, p < 0.001), but there was no difference in age, the duration of diarrhoea, CRP, or WBC. Of the patients who developed diarrhoea in the community, 21 (55.3%) were admitted from their own home with 23 (60.5%) returning there on discharge. Respective figures for patients that developed CDAD in hospital: 68 (69.4%) and 30 (30.6%, p < 0.001). Conclusions: Of hospitalised patients with CDAD, a significant proportion developed the disease in the community. A majority of these had been hospitalised over the preceding 12...


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