Digestive Diseases and Sciences

, Volume 47, Issue 1, pp 201–207

Epidemiology of Clostridium difficile Infection in a Large Population of Hospitalized US Military Veterans

  • Anna M. Buchner
  • Amnon Sonnenberg


The Patient Treatment File (PTF) of the Department of Veterans Affairs (VA) comprises the computerized records of all inpatients treated at all VA hospitals throughout the United States. The database was utilized to study the clinical epidemiology and impact of C. difficile colitis on health care among hospitalized US military veterans. The computerized medical records of 15,091 cases with C. difficile colitis and 61,931 controls without the diagnosis were extracted from the annual files between 1993 and 1998. Of all patients admitted to the hospital, 1% were diagnosed with C. difficile colitis, in 16% of whom it was listed as the primary discharge diagnosis. C. difficile colitis was more likely to occur in elderly white patients with multiple comorbid conditions. Compared with a control population of hospitalized patients without C. difficile colitis, the case population was subjected to more medical and surgical procedures and experienced longer hospital stays. The diagnosis of C. difficile colitis was associated with more frequent admissions to the intensive care unit and higher hospital-related and subsequent mortality. Eleven percent of the cases were admitted to hospital a second time after a mean of 202 days, 2.5% were readmitted a third time after an additional 182 days, and 0.8% were readmitted a fourth time after an additional 194 days. In conclusion, as old age, multiple comorbid conditions, a high number of medical and surgical intervention, and long hospitalization constitute the main risk factors for the development of C. difficile colitis, efforts at prevention should be directed primarily towards patients who present with these characteristics.

Clostridium difficile epidemiology infectious colitis pseudomembranous colitis 


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  1. 1.
    Fekety R, McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Mulligan ME: Recurrent Clostridium difficile diarrhea: Characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 24:324–333, 1997Google Scholar
  2. 2.
    McFarland LV, Surawicz CM, Stamm WE: Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 162:678–684, 1990Google Scholar
  3. 3.
    Brown E, Talbot GH, Axelrod P, Provencher M, Hoegg C: Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol 11:283–290, 1990Google Scholar
  4. 4.
    McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer KA: A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 271:1913–1918, 1994Google Scholar
  5. 5.
    McFarland LV, Mulligan ME, Kwok RYY, Stamm WE: Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320:204–210, 1989Google Scholar
  6. 6.
    Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN: Nosocomial Clostridium difficile colonization and disease. Lancet 336:97–100, 1990Google Scholar
  7. 7.
    Kelly CP, Pothoulakis C, LaMont JT: Clostridium difficile colitis. N Eng J Med 330:257–262, 1994Google Scholar
  8. 8.
    Cleary RK: Clostridium difficile-associated diarrhea and colitis: clinical manifestations, diagnosis, and treatment. Dis Colon Rectum 41:1435–1449, 1998Google Scholar
  9. 9.
    Pothoulakis C, LaMont JT: Clostridium difficile colitis and diarrhea. Gastroenterol Clin North Am 22:623–637, 1993Google Scholar
  10. 10.
    Delcò FR, Sonnenberg A: Associations between hemorrhoids and other diagnoses. Dis Colon Rectum 41:1534–1542, 1998Google Scholar
  11. 11.
    Delcò FR, El-Serag HB, Sonnenberg A: Celiac disease: Associated disorders and clinical manifestations. Dig Dis Sci 44:966–972, 1998Google Scholar
  12. 12.
    Surawicz CM, McFarland LV: Pseudomembranous colitis: Causes and cures. Digestion 60:91–100, 1999Google Scholar
  13. 13.
    Gerding DN, Johnson S, Peterson LP, Mulligan ME, Silva J: Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 16:459–477, 1995Google Scholar
  14. 14.
    Pear SM, Williamson TH, Bettin KM, Gerding DN, Galgiani JN: Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 120:272–277, 1994Google Scholar
  15. 15.
    Jobe BA, Grasley A, Deveney KE, Deveney CW, Sheppard BC: Clostridium difficile colitis: An increasing hospital-acquired illness. Am J Surg 169:480–483, 1995Google Scholar
  16. 16.
    Hirschorn LR, Trnka Y, Onderdonk A, Lee M-LT, Platt R: Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis 169:127–133, 1994Google Scholar
  17. 17.
    Zadik PM, Moore AP: Antimicrobial associations of an outbreak of diarrhoea due to Clostridium difficile. J Hosp Infect 39:189–193, 1998Google Scholar
  18. 18.
    Taylor ME, Oppenheim BA: Hospital-acquired infection in elderly patients. J Hosp Infect 38:245–260, 1998Google Scholar
  19. 19.
    Djuretic T, Wall PG, Brazier JS: Clostridium difficile: an update on its epidemiology and role in hospital outbreaks in England and Wales. J Hosp Infect 41:213–218, 1999Google Scholar
  20. 20.
    McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer G, Greenberg RN: Recurrent Clostridium difficile disease: Epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 20:43–50, 1999Google Scholar
  21. 21.
    Karlstrom O, Fryklund B, Tullus K, Burman LG: A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 26:141–145, 1998Google Scholar
  22. 22.
    Spencer RC: Clinical impact and associated costs of Clostridium difficile-associated disease. J Antimicrob Chemother 41(suppl C):5–12, 1998Google Scholar
  23. 23.
    Triadfilopoulos G, Shah MH, Pothoulakis C: The chemotactic response of human granulocytes to Clostridium difficile is age dependent. Am J Gastroenterol 86:1461–1465, 1991Google Scholar
  24. 24.
    Nakamura S, Mikawa M, Nakashio S, Takabatake M, Okado I, Yamakawa K: Isolation of Clostridium difficile from the feces and the antibody in sera of young and elderly adults. Microbiol Immunol 25:345–351, 1981Google Scholar
  25. 25.
    Kimmey MB, Elmer GV, Surawicz CM, McFarland LV: Prevention of further recurrences of Clostridium difficile colitis with Saccharomyces boulardii. Dig Dis Sci 35:897–901, 1990Google Scholar
  26. 26.
    Surawicz CM, McFarland LV: Recurrent Clostridium difficile disease. Clinical Perspectives Gastroenterol 2:100–103, 1999Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Anna M. Buchner
    • 1
  • Amnon Sonnenberg
    • 1
  1. 1.Department of Veterans Affairs Medical Center and theUniversity of NewAlbuquerqueMexico

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