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Ten Years of Prospective Clostridium difficile-Associated Disease Surveillance and Treatment at the Minneapolis VA Medical Center, 1982–1991

Published online by Cambridge University Press:  02 January 2015

Mary M. Olson ,
Carol J. Shanholtzer ,
James T. Lee Jr  and
Dale N. Gerding
Mary M. Olson*
Affiliation:
Departments of Surgery, Laboratory Medicine, and Medicine, Veterans Affairs Medical Center, and the University of Minnesota Medical School, Minneapolis, Minnesota
Carol J. Shanholtzer
Affiliation:
Departments of Surgery, Laboratory Medicine, and Medicine, Veterans Affairs Medical Center, and the University of Minnesota Medical School, Minneapolis, Minnesota
James T. Lee Jr
Affiliation:
Departments of Surgery, Laboratory Medicine, and Medicine, Veterans Affairs Medical Center, and the University of Minnesota Medical School, Minneapolis, Minnesota
Dale N. Gerding
Affiliation:
Departments of Surgery, Laboratory Medicine, and Medicine, Veterans Affairs Medical Center, and the University of Minnesota Medical School, Minneapolis, Minnesota
*
Department of Surgery (112), VA Medical Center, 1 Veterans Dr., Minneapolis, MN 55417
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Abstract

Objectives:

To understand the epidemiology, risks, and management of Clostridium difficile -associated disease (CDAD) and to establish and evaluate reliable methods of surveillance.

Design:

Case finding was done by daily ward and laboratory rounds. The criteria for CDAD diagnosis were: at least four unformed stools per day for 2 days and a positive culture or cytotoxin for C difficile, or positive endoscopy or autopsy for pseudomembranes.

Setting:

The surveillance covered all patients from 1982 through 1991 in the 820-bed Minneapolis Veterans Affairs Medical Center.

Participants:

The criteria were met by 908 patients. Medical service patients numbered 488; surgical patients, 420. Frequencies ranged from a high of 149 cases in 1982 to a low of 50 cases in 1989.

Results:

Stool specimens were obtained on 898 (99%) of the 908 CDAD patients. Stools were culture-positive in 864 (96%) of 898, cytotoxin-positive in 569 (63%) of 898. Endoscopy was performed on 196 (22%) of the 908 patients, and 80 (41%) of 196 patients had pseudomembranes. Ten (1%) of the 908 patients were diagnosed by endoscopy without a stool specimen, or at autopsy. No treatment was needed for 135 (15%) of the 908 CDAD patients, and 19 (2%) of the 908 died before treatment was started. Oral metronidazole was the treatment for 632 (70%) of 908 patients (1% intolerance, 2% failure, 7% relapse) and oral vancomycin was given to 122 (13%) of 908 patients (1% intolerance, 1% failure, 10% relapse). Twelve patients had pseudomembranous colitis at autopsy, and it was the primary cause of death in 5 (0.6%) of 908.

Conclusions:

CDAD usually responds to oral metronidazole or vancomycin but is nonetheless responsible for a high morbidity and occasional mortality in patients even when the diagnosis and treatment are pursued aggressively.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 6 , June 1994 , pp. 371 - 381
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

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