CLOSTRIDIUM-DIFFICILE COLITIS - AN INCREASING HOSPITAL-ACQUIRED ILLNESS

BACKGROUND: Colitis caused by Clostridium difficile is receiving incre ased attention as a nosocomial hospital-acquired infection. METHODS: T o determine the incidence of C difficile colitis in our facility and t he relative proportion of patients dying from the colitis or requiring colectomy for it, we retrospectively reviewed 201 cases of colitis ca used by C difficile from 1984 to 1994. RESULTS: The incidence of C dif ficile colitis ap pears to be sharply increasing and is associated wit h the use of cephalosporins. Among patients who subsequently developed C difficile colitis, the most frequent indication for antibiotic use was perioperative prophylaxis; surgical patients comprised 55% of the total cases. Surgical intervention was required for 5% of patients wit h C difficile colitis, with an operative mortality of 30%. The overall mortality was 3.5% and was associated with a delay in diagnosis. The only discriminative factor between patients who died and those who sur vived was length of time from symptoms to treatment-5.43 days for surv ivors versus 10.7 days for those who died (P <0.05). CONCLUSIONS: Most cases of C difficile colitis seen by surgeons have followed the use o f perioperative prophylactic antibiotics, Strict guidelines for using perioperative antibiotics should be observed. Prompt recognition of C difficile colitis and aggressive therapy for it are essential for a fa vorable outcome.