A Study of Clostridium difficile-Associated Disease at King Chulalongkorn Memorial Hospital, Thailand
Jakrapan Pupaibool MD*, Mayuree Khantipong MSc**, Chusana Suankratay MD*
Affiliation : * Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok ** Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok
Background : Currently, in established antibiotic era, there is a widespread and increasing use of broad-
spectrum antibiotics. Clostridium difficile, one of the troublesome intruders, flourishes when normal gut flora
is altered by antibiotics. C. difficile is recognized as a frequent and leading cause of antibiotic-associated
diarrhea and colitis. It causes substantial morbidity and mortality in hospitalized patients.
Objective : The present study was aimed at determining patient characteristics, clinical features, treatment,
and outcomes of C. difficile-associated disease (CDAD) in hospitalized patients at King Chulalongkorn
Memorial Hospital, Bangkok, Thailand.
Material and Method: From 2002 to 2005, 88 patients with positive latex immunoassay for C. difficile toxin
A were identified. Data from medical records of 56 patients were available for analysis.
Results : Of 56 patients, there were 28 males and 28 females, with the mean age of 47.39 years (range: 4 months
to 93 years). 50 (89.3%) patients had underlying illnesses with hematological malignancies (14 patients,
25%) and solid tumors (15 patients, 26.8%) being the most common. All patients had a history of antibiotic
use including current (17 patients, 30.4%), recent (16 patients, 28.6%), or both current and recent uses (23
patients, 41.1%). Cephalosporins and carbapenems were the two most commonly prescribed antibiotics. 25
(44.6%) patients were receiving either omeprazole or ranitidine. 12 (21.4%) patients had received chemo-
therapy within two months before CDAD diagnosis. Of 50 stool specimens examined, only 26 (52%) had white
or red blood cells. Colonoscopy was performed in only three patients, and pathological findings revealed
non-specific colitis. Oral metronidazole, intravenous metronidazole, and vancomycin were prescribed for
CDAD treatment in 38 (67.9%), 4 (7.1%), and 2 (3.6%) patients, respectively. 8 (14.3%) patients had no
specific treatment, and the offending antibiotic was not discontinued in three of them. An overall initial
response rate was 66.7%. 2 patients relapsed after metronidazole treatment.
Conclusion : The present study is the first in Southeast Asia to describe the decreased initial response rate of
metronidazole treatment of CDAD. The reasons for this relatively poor response in the presented patients need
to be determined in a future study.
Keywords : Clostridium difficile, Clostridium difficile-associated disease, Diarrhea, Antibiotic-associated diarrhea, Colitis, Pseudomembrane
