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What is the risk factor for severe clostridium difficile-associated diarrhea?

World Journal of Gastroenterology

Clostridium difficile associated diarrhoea (CDAD) is the most common cause of healthcare-associated diarrhoea and results in a wide spectrum of disease severity ranging from asymptomatic carriage to life-threatening entero-colitis and death. While many studies have investigated risk factors for infection with C. difficile and subsequent development of CDAD, little is known about risk factors associated with a severe course of CDAD in hospitalised patients.

A research article to be published on July 21, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Franz Ludwig Dumoulin from Gemeinschaftskrankenhaus Bonn of German conducted a retrospective chart review on 124 hospitalised patients to identify risk factors for severe CDAD (associated with systemic signs of hypovolemia). The study was conducted in community hospital treating approximately 19 000 in-patients per year. Major findings of the analysis are a 22% rate of severe CDAD which was significantly associated with a high 30-day mortality (33% vs 4%, P < 0.001) and a hospital stay exceeding 14 d (74% vs 52%, P = 0.048). In addition, co-morbidity assessed by the Charlson co-morbidity score (P < 0.05) and levels of serum C-reactive protein at the time of diagnosis (P < 0.001) were independent predictors of a severe course.

The findings have considerably impact on everyday clinical practice. Thus, hospitalized patients with a severe level of co-morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention and treatment to counteract the threat of severe CDAD.


Reference: Hardt C, Berns T, Treder W, Dumoulin FL. Univariate and multivariate analysis of risk factors for severe clostridium difficile-associated diarrhoea: Importance of co-morbidity and serum C-reactive protein. World J Gastroenterol 2008;14(27): 4338-4341

Correspondence to: Professor Franz Ludwig Dumoulin, MD, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, Bonn D-53113, Germany.
Telephone: +49-228-5081561 Fax: +49-228-5081562

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

About The WJG Press

The WJG Press mainly publishes World Journal of Gastroenterology.

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