370. Predictive Factors for Clostridium difficile Diarrhea in Patients Receiving Empirical Therapy
Session: Poster Session: Bacterial Diseases
Friday, October 7, 2005: 12:00 AM
Room: Exhibit Hall A
Introduction: Clostridium difficile colitis is a significant cause of nosocomial diarrhea. Hospitalized patients with diarrhea are often treated empirically with oral metronidazole or oral vancomycin while awaiting a definitive diagnosis. The current study was designed to identify predictive factors which would assist in selection of patients with true C. difficile colitis who would benefit from empirical therapy.
Methods: The charts of all patients receiving oral metronidazole or oral vancomycin for suspected C. difficile colitis from 7/1/2001 to 3/31/2002 were retrospectively reviewed for the following factors: age, race, number of comorbidities, patient admittance to a critical care unit, history of C. difficile in the last 200 days, antibiotic usage, number of days between antibiotic initiation and symptoms, WBC count, type of symptoms, GI procedures, serum creatinine, usage of steroids, history of malignancy, chemotherapy, presence of NG tube, NH resident status, temperature, previous hospitalization, time since previous hospitalization, and time in hospital before diarrhea.
Results: Leukocytosis exceeding 19000, prior usage of clindamycin or cephalosporins, and hospitalization within 6 months were independent factors predictive of a positive C. difficile toxin assay. Sixty four percent of treated patients had negative toxin assays.
Among patients with at least two of these predictors, only 16% had negative C. difficile toxin assays.
These data suggest that using these predictors in selecting patients for empirical treatment could significantly reduce unnecessary antimicrobial usage and resultant risk of antimicrobial resistance.
Surprisingly, in this study, admission to a critical care unit, age, and nursing home residence were not independent predictors.
Conclusion: In this study, the majority of patients with nosocomial diarrhea treated with metronidazole or vancomycin had a negative C. difficile toxin assay. We identified three independent factors that predict a positive C. difficile toxin. If empiric therapy is restricted to patients with two or more of these predictors, the unnecessary use of antimicrobials can be reduced.
Anurag Duggal, MD1, William Gardner, MD1 and  A. Duggal, None; W.G. Gardner, None., (1)Akron General Medical Center, Akron, OH

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