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Who are Susceptible to Pseudomembranous Colitis Among Patients with Presumed Antibiotic-Associated Diarrhea?

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Diseases of the Colon & Rectum

Purpose

Pseudomembranous colitis is a severe form of antibiotic-associated diarrhea. However, there have been no reports about the factors that make patients with presumed antibiotic-associated diarrhea susceptible to pseudomembranous colitis. This study was designed to determine the clinical risk factors for pseudomembranous colitis among the patients with presumed antibiotic-associated diarrhea.

Methods

This was a retrospective study of 150 consecutive patients admitted to our institution between January 2000 and December 2004 with a diagnosis of presumed antibiotic-associated diarrhea. All patients underwent sigmoidoscopy or colonoscopy because of diarrhea after administration of antibiotics. Pseudomembranous colitis was confirmed both endoscopically and histologically. Various clinical parameters were compared between the pseudomembranous colitis group and non-pseudomembranous colitis group.

Results

The mean age of patients was 61 years, and 60 percent (90/150) was female. Pseudomembranous colitis was diagnosed in 53 percent (80/150). On univariate analysis, older than aged 70 years (P = 0.014), antibiotic therapy for more than 15 days (P < 0.0001), hospital stay for more than 20 days (P < 0.0001), number of antibiotics used more than one (P = 0.01), and surgical procedures (P = 0.029) were significant parameters for pseudomembranous colitis. On multivariate analysis, the important clinical risk factors were advanced age (older than aged 70 years; adjusted odds ratio, 2.7; 95 percent confidence interval, 1.208–6.131; P < 0.016) and long hospital stay (more than 20 days; adjusted odds ratio, 5.1; 95 percent confidence interval, 2.1–12.259; P < 0.0001). When both risk factors were present, the positive predictive value of pseudomembranous colitis was 0.86.

Conclusions

Advanced age and long hospital stay may make patients with presumed antibiotic-associated diarrhea susceptible to pseudomembranous colitis. Therefore, pseudomembranous colitis should be first suspected in cases with presumed antibiotic-associated diarrhea having such risk factors.

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Authors and Affiliations

  1. Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea

    Ki Sung Lee M.D., Woon Geon Shin M.D., Myoung Kuk Jang M.D., Hyoung Su Kim M.D., Hee Seon Kim M.D., Chi Jun Park M.D., Ja Young Lee M.D., Kyung Ho Kim M.D., Joon Young Park M.D., Jin Heon Lee M.D., Hak Yang Kim M.D. & Jae Young Yoo M.D.

  2. Department of Pathology, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea

    Sung Jin Cho M.D.

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  1. Ki Sung Lee M.D.
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Correspondence to Myoung Kuk Jang M.D..

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Lee, K.S., Shin, W.G., Jang, M.K. et al. Who are Susceptible to Pseudomembranous Colitis Among Patients with Presumed Antibiotic-Associated Diarrhea?. Dis Colon Rectum 49, 1552–1558 (2006). https://doi.org/10.1007/s10350-006-0694-z

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  • DOI: https://doi.org/10.1007/s10350-006-0694-z

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