Clostridium difficile colitis: an increasing hospital-acquired illness

Am J Surg. 1995 May;169(5):480-3. doi: 10.1016/S0002-9610(99)80199-8.


Background: Colitis caused by Clostridium difficile is receiving increased attention as a nosocomial hospital-acquired infection.

Methods: To determine the incidence of C difficile colitis in our facility and the relative proportion of patients dying from the colitis or requiring colectomy for it, we retrospectively reviewed 201 cases of colitis caused by C difficile from 1984 to 1994.

Results: The incidence of C difficile colitis appears to be sharply increasing and is associated with the use of cephalosporins. Among patients who subsequently developed C difficile colitis, the most frequent indication for antibiotic use was perioperative prophylaxis; surgical patients comprised 55% of the total cases. Surgical intervention was required for 5% of patients with C difficile colitis, with an operative mortality of 30%. The overall mortality was 3.5% and was associated with a delay in diagnosis. The only discriminative factor between patients who died and those who survived was length of time from symptoms to treatment--5.43 days for survivors versus 10.7 days for those who died (P < 0.05).

Conclusions: Most cases of C difficile colitis seen by surgeons have followed the use of perioperative prophylactic antibiotics. Strict guidelines for using perioperative antibiotics should be observed. Prompt recognition of C difficile colitis and aggressive therapy for it are essential for a favorable outcome.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Cephalosporins / adverse effects
  • Cephalosporins / therapeutic use
  • Child
  • Child, Preschool
  • Cholestyramine Resin / therapeutic use
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Cross Infection / therapy
  • Drug Therapy, Combination
  • Enterocolitis, Pseudomembranous / epidemiology*
  • Enterocolitis, Pseudomembranous / etiology
  • Enterocolitis, Pseudomembranous / therapy
  • Female
  • Fluid Therapy
  • Hospital Mortality
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Infant
  • Male
  • Metronidazole / therapeutic use
  • Middle Aged
  • Premedication / adverse effects
  • Retrospective Studies
  • Surgical Procedures, Operative / methods
  • Survival Rate
  • Vancomycin / therapeutic use


  • Anti-Bacterial Agents
  • Cephalosporins
  • Immunosuppressive Agents
  • Cholestyramine Resin
  • Metronidazole
  • Vancomycin