Risk factors for severity and relapse of pseudomembranous colitis in an elderly population

Meta-analysis to assess risk factors for recurrent Clostridium difficile infection

SUMMARY

Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhoea. It is estimated that 15-20% of patients experience recurrence of CDI. A limited number of studies have looked at the risk factors for recurrent CDI. We conducted a meta-analysis of observational studies and randomised controlled trials (RCTs) to assess risk factors for recurrent CDI. Studies were identified using the PubMed database and search terms 'Clostridium difficile associated diarrhoea' or 'pseudomembranous colitis'. Both observational studies and RCTs were included. In all, 1215 studies were identified of which 48 met the inclusion criteria. Twelve studies involving 1382 patients with CDI met the complete eligibility requirements. Odds ratios and information on study quality were abstracted by two investigators independently. To be included in the analysis, each risk factor was required to be evaluated by at least three separate studies. Continued use of non-C. difficile antibiotics after diagnosis of CDI (OR: 4.23; 95% CI: 2.10-8.55; P<0.001), concomitant receipt of antacid medications (OR: 2.15; 95% CI: 1.13-4.08; P=0.019), and older age (OR: 1.62; 95% CI: 1.11-2.36; P=0.0012) were significantly associated with increased risk of recurrent CDI. Significant prognostic risk factors were identified as risk factors for CDI recurrence. Additional or novel interventions may be required for these patients to prevent CDI recurrence.

Clostridium difficile-associated diarrhea with hematochezia is associated with ulcer formation

OBJECTIVE

Clostridium difficile-associated diarrhea (CDAD) is a well-known iatrogenic infection with typical endoscopic features including pseudomembranes and intervening normal mucosa. Clinically, diarrhea frequently occurs, but occurrence of hematochezia is rare. The objective of this study was to investigate the background and endoscopic features of CDAD patients with hematochezia.

MATERIAL AND METHODS

The endoscopic and clinical findings in 12 patients who showed evidence of C. difficile toxin A and who underwent colonoscopy between April 2002 and July 2007 were investigated retrospectively.

RESULTS

Eight patients were diagnosed as having CDAD and 4 patients had a diagnosis of ulcerative colitis. Six of the patients with CDAD presented with hematochezia, and 4 of them were diagnosed with hematological malignancies and received anticancer chemotherapy. Colonic ulcer was demonstrated in all CDAD patients with hematochezia, and bleeding from the ulcer was endoscopically confirmed in all of them.

CONCLUSIONS

CDAD accompanied by hematochezia is closely associated with ulcer formation. Ulcers are thought to occur during recovery from nadir after anticancer treatment, and white blood cells appear to be essential for their formation. Physicians should therefore pay close attention to the occurrence of colonic ulcer, especially in patients with CDAD during recovery from nadir.

Univariate and multivariate analysis of risk factors for severe clostridium difficile-associated diarrhoea: Importance of co-morbidity and serum C-reactive protein

AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalized patients.

METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalized patients by retrospective chart review.

RESULTS: Severe CDAD was present in 27 patients (22%). Statistical analysis showed a significant association with a higher 30-d mortality (33% vs 4%, P < 0.001) and a higher proportion of longer hospital stay exceeding 14 d (74% vs 52%, P = 0.048). Charlson co-morbidity score (OR 1.29 for 1 point increment, P < 0.05) and serum C-reactive protein at diagnosis (OR 1.15 for 10 mg/L increment, P < 0.001) were independent predictors of severe CDAD.

CONCLUSION: Patients with a severe level of co-morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.