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Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study
Archives of Internal Medicine
|January 1, 1986
Summary
Clostridium difficile-associated diarrhea is often misdiagnosed. Only 20% of cases showed actual C. difficile infection, highlighting the need for accurate diagnostic methods like cytotoxin testing.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Clostridium difficile-associated diarrhea (CDAD) is a significant nosocomial infection, predominantly affecting surgical services.
- Accurate diagnosis of CDAD is crucial for effective patient management and infection control.
Purpose of the Study:
- To compare diagnostic methods for Clostridium difficile infection (CDI).
- To identify risk factors and clinical characteristics associated with CDI.
Main Methods:
- A one-year study comparing 149 adult patients with diarrhea/colitis to 148 diarrhea-free controls.
- Diagnostic methods included stool cytotoxin assays and stool cultures.
- Endoscopy was used to identify pseudomembranes.
Main Results:
- Only 20% of suspected CDAD cases were confirmed as true C. difficile infections.
- Stool cytotoxin testing and pseudomembrane presence were more indicative of CDI than stool culture alone.
- Patients with confirmed CDI had longer hospitalizations, more antecedent infections, and higher rates of clindamycin and multiple antimicrobial use compared to controls.
Conclusions:
- Stool culture alone is insufficient for diagnosing C. difficile-associated diarrhea.
- Cytotoxin testing and endoscopic findings are more reliable indicators of active C. difficile infection.
- Understanding risk factors like prior antimicrobial exposure is key for preventing CDI.