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Clostridium difficile colitis associated with chronic renal failure
R J Cunney1, C Magee, E McNamara
1Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
Insights
Clostridium difficile-associated diarrhoea (CDAD) is a serious threat in nephrology patients, particularly those with chronic renal failure (CRF), leading to high mortality. Early diagnosis and rational antibiotic use are crucial for managing this condition.
Area of Science:
- Nephrology
- Infectious Diseases
- Microbiology
Background:
- Clostridium difficile-associated diarrhoea (CDAD) presents a significant health risk, disproportionately affecting patients with chronic renal failure (CRF).
- A focused review was conducted within a nephrology unit to investigate CDAD prevalence and characteristics.
Purpose of the Study:
- To determine the incidence and impact of CDAD in a nephrology patient population.
- To identify risk factors, clinical presentations, and outcomes associated with CDAD in CRF patients.
Main Methods:
- A retrospective review of 32 CDAD cases over 24 months using microbiology and histology records.
- Analysis of patient notes for risk factors, clinical features, and outcomes.
- 16S ribosomal RNA typing was performed on available C. difficile isolates.
Main Results:
- Nephrology unit CDAD incidence was 10.7/1000 admissions, significantly higher than other hospital areas (2.7/1000).
- CDAD was a principal cause of death in 19% and a contributing factor in 22%; mortality was higher in CRF patients (P=0.04).
- Inappropriate antibiotic therapy was noted in 15 of 26 patients with recent antibiotic use.
Conclusions:
- CDAD poses a high mortality risk for nephrology patients, especially those with CRF.
- Missed diagnoses can occur without thorough antibiotic history, including pre-admission agents.
- Rational antibiotic prescribing and infection control are essential to mitigate CDAD incidence.
Background:
Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patients with chronic renal failure (CRF) than in other groups. A review of CDAD in our nephrology unit was carried out.
Methods:
A review of microbiology and histology records identified 32 cases of CDAD in the nephrology unit over a 24-month period. Patient notes were reviewed to identify risk factors, clinical features and outcome. Available isolates of C. difficile underwent 16S ribosomal RNA typing.
Results:
The incidence of CDAD in the nephrology unit was 10.7 per 1000 admissions, compared to 2.7 per 1000 in other areas of the hospital (P<0.0001). CDAD was considered the sole or principal cause of death in six (19%) and was considered a contributing factor in a further seven (22%). Mortality was significantly higher among patients with established CRF (P=0.04). Seven cases occurred as a cluster, over a 1-month period. Isolates from this cluster, along with comparative strains from other areas of the hospital, were found to be PCR type 1. Diarrhoea occurred in 28 (89%) of cases, pyrexia in 17 (53%) and ileus or abdominal pain in 14 (44%). Six patients responded to discontinuation of antibiotics alone and 22 required metronidazole and/or vancomycin. Three patients had colectomy and one caecostomy because of toxic megacolon. Four patients died before specific therapy could be given and in two of these cases the diagnosis was made at autopsy. Twenty-six patients had a record of recent antibiotic therapy. Of these, 15 had at least one agent considered to be inappropriate (excessively broad spectrum agent in 11, excessive duration of therapy in four). Nine patients had only received antibiotics prior to admission.
Conclusions:
CDAD carries a high mortality in nephrology patients, especially those with established CRF. The diagnosis may be missed if a careful antibiotic history is not taken, including agents received prior to admission. Rational antibiotic prescribing and adherence to infection control measures are vital to reduce the incidence of this serious condition.