Recurrent Clostridium difficile disease: Epidemiology and clinical characteristics

OBJECTIVE: To describe the epidemiology, diagnosis, risk factors, patient i mpact, and treatment strategies for recurrent Clostridium difficile-associa ted disease (CDAD). DESIGN: Data were collected as part of a blinded, placebo-controlled clinic al trial testing a new combination treatment for recurrent: CDAD. Retrospec tive data regarding prior CDAD episodes were collected from interviews and medical-chart review. Prospective data on the current CDAD episode, risk fa ctors, and recurrence rates were collected during a 2-month follow-up. SETTINGS: National referral study. PARTICIPANTS: Patients with recurrent CDAD. INTERVENTIONS: Treatment with a 10-day course of low-dose (500 mg/d or high -dose (2 g/d) vancomycin or metronidazole (1 g/d). RESULTS: Recurrent CDAD was found to have a lengthy course involving multip le episodes of diarrhea, abdominal cramping, nausea, and fever. CDAD may re cur over several years despite frequent treatment with antibiotics. Recurre nce rates were similar regardless of the choice or dose of antibiotic. Recu rrent CDAD is not a trivial disease: patients may have multiple episodes la s many as 14), may require hospitalization, and the mean lifetime cost of d irect medical care was $10,970 per patient Fortunately, the disease does no t become progressively more severe as the number of episodes increase. Two risk factors predictive for recurrent CDAD were found: increasing age and a decreased quality-of-life score at enrollment CONCLUSIONS: Recurrent CDAD is a persistent disease that may result in prol onged hospital stays, additional medical costs, and rare serious complicati ons.