Nephrology Dialysis Transplantation, Vol 13, Issue 11 2842-2846, Copyright © 1998 by Oxford University Press
R Cunney, C Magee, E McNamara, E Smyth and J Walshe
Background: Clostridium difficile-associated diarrhoea
(CDAD) is a potentially life-threatening illness which has been shown to be
more common and more severe in patients with chronic renal failure (CRF)
than in other groups. A review of CDAD in our nephrology unit was carried
out. Methods: A review of microbiology and histology
records identified 32 cases of CDAD in the nephrology unit over a 14-month
period. Patient notes were reviewed to identify risk factors, clinical
features and outcome. Available isolates of C.
difficile underwent 16S ribosomal RNA typing.
Results: The incidence of CDAD in the nephrology unit
was 10.7 per 1000 admissions, compared to 2.7 per 1000 in other areas of
the hospital (P<0.0001). CDAD was considered the sole or principal
cause of death in six (19%) and was considered a contributing factor in a
further seven (22%). Mortality was significantly higher among patients with
established CRF (P=0.04). Seven cases occurred as a cluster, over a 1-month
period. Isolates from this cluster, along with comparative strains from
other areas of the hospital, were found to be PCR type 1. Diarrhoea
occurred in 28 (89%) of cases, pyrexia in 17 (53%) and ileus or abdominal
pain in 14 (44%). Six patients responded to discontinuation of antibiotics
alone and 22 required metronidazole and/or vancomycin. Three patients had
colectomy and one caecostomy because of toxic megacolon. Four patients died
before specific therapy could be given and in two of these cases the
diagnosis was made at autopsy. Twenty-six patients had a record of recent
antibiotic therapy. Of these, 15 had at least one agent considered to be
inappropriate (excessively broad spectrum agent in 11, excessive duration
of therapy in four). Nine patients had only received antibiotics prior to
admission. Conclusions: CDAD carries a high mortality
in nephrology patients especially those with established CRF. The diagnosis
may be missed if a careful antibiotic history is not taken, including
agents received prior to admission. Rational antibiotic prescribing and
adherence to infection control measures are vital to reduce the incidence
of this serious condition. Key words: antibiotics;
chronic renal failure; Clostridium difficile; colitis;
uraemia
ORIGINAL ARTICLES
Clostridium difficile colitis associated with chronic renal failure
Departments of Clinical Microbiology and Nephrology, Beaumont Hospital, Dublin, Ireland; Corresponding author at: Services of Infectious Diseases, Hamilton Health Sciences corporation, McMaster University Medical Center, Room 2N33, 1200 Main Street West, Hamilton ON L8N 3Z5, Canada
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