RECURRENT CLOSTRIDIUM-DIFFICILE DIARRHEA - CHARACTERISTICS OF AND RISK-FACTORS FOR PATIENTS ENROLLED IN A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED TRIAL

Recurrent Clostridium difficile diarrhea (RCDD) occurs in 20% of patie nts after they have received standard antibiotic treatment with vancom ycin or metronidazole, but the reasons for the recurrences are largely unknown, Patients receiving vancomycin or metronidanole for active C, difficile diarrhea (CDD) were referred to our study centers for treat ment and a 2-month follow-up as part of a randomized placebo-controlle d trial. Sixty patients had RCDD (median number of episodes, 3.0; rang e, 2-9 episodes) and 64 were having their first episode of CDD. Patien ts with RCDD had more-severe abdominal pain and were more likely to ha ve fever but initially responded well to antibiotic therapy, Data on s equential episodes showed no progression in disease severity, Five fac tors were associated with a higher risk of RCDD: the number of previou s CDD episodes, onset of the initial disease in the spring, exposure t o additional antibiotics for treatment of other infections, infection with immunoblot type 1 or 2 strains of C. difficile, and female gender , These factors may help to identify patients who are more likely to d evelop RCDD and require careful medical supervision.