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The impact of pseudomembrane formation on the outcome of Clostridium difficile-associated disease

  • Clinical and Epidemiological Study
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Abstract

Purpose

Although pseudomembranes are the hallmark manifestation of Clostridium difficile-associated diarrhea (CDAD), there are scant data specifically addressing their impact on the clinical outcome. We investigated whether the formation of pseudomembranes predicts a worse CDAD outcome.

Methods

CDAD patients hospitalized during 2010 underwent sigmoidoscopy and were followed prospectively. In addition, all hospitalized CDAD patients in the period 01/2000–12/2009 who underwent lower endoscopy were retrospectively identified and their charts reviewed. Patients with detectable pseudomembranes on endoscopy were compared to those in whom pseudomembranes were absent. Thirty-day mortality and a composite outcome comprised of mortality within 30 days of diagnosis, admission to the intensive care unit (ICU), colectomy, peritonitis, hemodynamic instability, or respiratory insufficiency were addressed. Additional clinical outcomes used for comparison between the two groups were 60-day mortality, duration of hospitalization, and the failure of metronidazole and vancomycin.

Results

A total of 117 CDAD patients (mean age 62.9 ± 19 years) who underwent lower endoscopy were included; 46 with pseudomembranes and 71 without. Seven out of the 46 patients with pseudomembranes died within 30 days compared to 9/71 in the non-pseudomembrane group [odds ratio (OR) 1.2, 95 % confidence interval (CI) 0.4–3.6, P = 0.8]. Similarly, there was no correlation between the occurrence of pseudomembranes and the rate of the composite adverse outcome (P = 0.6). In contrast, acute renal insufficiency (OR 15, 95 % CI 3.2–72, P < 0.001) and hypoalbuminemia (OR 5.7, 95 % CI 1.8–18, P = 0.002) were both independently predictive of a severe clinical outcome.

Conclusions

Our findings suggest that the presence of pseudomembranes is not associated with an adverse outcome in CDAD patients.

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Abbreviations

CDAD:

Clostridium difficile-associated diarrhea

EIA:

Enzyme immunoassay

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Acknowledgments

Funding: supported in part by the Talpiot Medical Leadership Program at the Sheba Medical Center (to S.B.-H.).

Conflict of interest

S.B.-H. has received advisory board fees from Optimer Pharmaceuticals. All other authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Center for Liver Diseases, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel

    T. Berdichevski

  2. Infectious Disease Unit, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel

    N. Keller & G. Rahav

  3. Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, 52621, Ramat Gan, Israel

    S. Bar-Meir, R. Eliakim & S. Ben-Horin

Authors
  1. T. Berdichevski
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  2. N. Keller
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  3. G. Rahav
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  4. S. Bar-Meir
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  5. R. Eliakim
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  6. S. Ben-Horin
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Corresponding author

Correspondence to S. Ben-Horin.

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Berdichevski, T., Keller, N., Rahav, G. et al. The impact of pseudomembrane formation on the outcome of Clostridium difficile-associated disease. Infection 41, 969–977 (2013). https://doi.org/10.1007/s15010-013-0473-4

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  • DOI: https://doi.org/10.1007/s15010-013-0473-4

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