Clostridium difficile-associated diarrhea (CDAD) is a hospital acquired infection.
In this study, physicians from Nottingham, England, evaluated 136 hospitalized patients with CDAD.
The team assessed patients whose diarrhea onset was in the community, as well as investigating the role of bedside flexible sigmoidoscopy in diagnosis.
In patients whose diarrhea was of unknown etiology, flexible sigmoidoscopy was compared with stool assay for C. difficile cytotoxin.
The team found that 96% of patients had CDAD associated with antibiotic exposure.
|In 72% of patients diarrhea stated while in hospital.|
They determined that in 28% of patients diarrhea started in the community, in the remaining 72% diarrhea stated while an inpatient.
However, the team found that the majority with CDAD onset in the community had been hospitalized over the preceding 12 months (87%).
There were 56 patients with pseudomembranous colitis at sigmoidoscopy. In 52% of these patients the stool C. difficile cytotoxin test was negative, but toxigenic C. difficile was isolated from all of the 9 stool samples cultured.
Dr Johal's team concluded, "In a significant proportion of hospitalized patients with CDAD, diarrhea started in the community".
"However, the majority of these had been hospital inpatients previously when they may have acquired C. difficile, with the subsequent onset of diarrhea in the community following exposure to antibiotics".
"Flexible sigmoidoscopy is superior to the stool C. difficile cytotoxin test in a subgroup of patients with pseudomembranous colitis".
"Sigmoidoscopy should therefore be considered in all hospitalized patients with diarrhea in whom the stool test for C. difficile cytotoxin and enteric pathogens is negative".