THE CLINICAL SPECTRUM OF CLOSTRIDIUM-DIFFICILE COLITIS IN IMMUNOCOMPROMISED PATIENTS

Clostridium difficile colitis is a nosocomial infection that continues to cause significant hospital morbidity despite adequate treatment. T his morbidity may be especially costly in the immunocompromised patien t who now makes up a greater percentage of hospitalized patients. The purpose of this study was to evaluate if patients in immunocompromised states are at risk for relapse of Clostridium difficile colitis, and to determine the efficacy of metronidazole in these patients. A retros pective chart review was conducted of patients with Clostridium diffic ile colitis over a 1-year period between 1990 and 1991. From this stud y group, 114 patients were identified who had both positive Clostridiu m difficile toxin assays of fecal specimens and documented in-house cl inical infection. There were 67 immunocompromised patients (59%) in th e study group. Oral vancomycin was given alone in 41 (36%) patients, m etronidazole was used in 36 (32%) patients, and a combination was give n in 15 (13%) patients. Twenty-two (19%) patients received no antibiot ic therapy and had their preceding antibiotics terminated. Twelve (10. 5%) patients had documented relapses, and all had an immunocompromisin g condition. There was no statistically significant difference in rela pse rates between the vancomycin and metronidazole-treated patients. W e conclude that metronidazole, with its significantly lower cost, shou ld be used as first-line therapy in immunocompromised patients.