The development of fulminant Clostridium difficile colitis requires prompt operative intervention, and is associated with a high mortality rate.
Dr Alexander Greenstein and colleagues designed a case-control study to define the clinical and laboratory parameters that predict which patients with C difficile infection are most likely to progress to fulminant C difficile colitis.
|An independent risk factor was white blood cell count of 16,000 cells/mm3|
The team retrospectively evaluated documented in-hospital progression of C difficile infection to fulminant C difficile colitis from 1994 to 2006.
The patients were matched at the start of medical therapy by age, sex, and intensive care unit status to controls with C difficile infection who did not develop fulminant C difficile colitis.
Chi-Square and multivariable logistic regression were used to identify risk factors for progression to fulminant C difficile colitis.
The researchers found a total of 35 patients with fulminant C difficile colitis.
There were 70 controls with C difficile infection who did not develop fulminant C difficile colitis.
The patients with fulminant C difficile colitis underwent colectomy after an average of 5 days of medical therapy, and had a mortality rate of 40%.
The team found that independent risk factors for the development of fulminant C difficile colitis was a white blood cell count of 16,000 cells/mm3 at initiation of therapy.
Operative therapy within the last 30 days, a history of inflammatory bowel disease, and a history of intravenous immunoglobulin treatment were also independent risk factors.
Dr Greenstein's team concluded, "Leukocytosis, recent prior operative therapy, and a history of inflammatory bowel disease and intravenous immunoglobulin treatment were negative prognostic indicators for patients with C difficile infection."
"The presence of these factors merits close observation for progression to fulminant C difficile colitis and acceleration of the planning process for operative intervention."