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Original Articles
Prognosis Factors of Clostridium difficile Associated Diarrhea
Joon Hyung Kim, M.D.1, Hee Jung Kim, M.D.2,3, Nam Su Ku, M.D.1, Young Keun Kim, M.D.1,4, Jun Yong Choi, M.D.1,4So Youn Shin, M.D.1,4, Yoon Seon Park, M.D.1,4, Yeon-A Kim, M.D.1,4, Myung Soo Kim, M.D.1,4, Su Jin Jeong, M.D.1Hee Kyung Choi, M.D.1, Young G
1Department of Internal Medicine, 2Department of Laboratory Medicine, 3Research Institute of Bacterial Resistance and 4AIDS Research Institute Yonsei University College of Medicine, Seoul, Korea
Vol.39 Num.2 (p71~77)
Background:Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood.
Materialsand Methods:A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge.
Results:Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P<0.001) as the independent poor prognostic factors.
Conclusion:Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.
Keywords : Clostridium difficile, Clostridium difficile associated diarrhea, Prognosis factors, Diarrhea