340. Presentation of Clostridium difficile infection among patients with spinal cord injury
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: Spinal cord injury patients are at risk for C. difficile infection (CDI) due to frequent antibiotic use and long lengths of hospital stay.  Many of these patients have neurogenic bowel, which could alter the presenting symptoms of CDI.  However, only a handful of case reports are available which have described CDI presentation in this population.

Methods: We performed a retrospective case series of 35 patients with spinal cord injury and CDI from 2006 to 2010 at the Cleveland VA Medical Center.  Information was collected pertaining to demographics, past medical history, and CDI presentation, treatment, and recurrence.    

Results: Of 35 patients, 34 (97%) were male and the mean age was 60.2 years (SD=12).  Thirty-three (94%) had neurogenic bowel.  Thirty-four (97%) had received antibiotics in the last 3 months, and 19 (54%) had been hospitalized in the past 12 months.  Eight (23%) had a history of prior CDI.  All of the patients presented with a change in bowel habits (diarrhea, unformed stool, or incontinence with liquid stool).  At the time of diagnosis, 14 (43%) had leukocytosis (white blood cell count >11,000 cells/cmm), 7 (20%) were febrile, and 12 (34%) had autonomic dysreflexia.  According to the criteria from current CDI guidelines, 9 (26%) were defined as severe, and 7 (20%) as severe complicated.  All 7 of the severe, complicated cases were defined as such due to hypotension (decrease of greater than 25% in mean arterial pressure) rather than shock or ileus. Of the 30 patients treated with metronidazole, 10 (33%) failed treatment and were switched to vancomycin.  Twelve patients (34%) developed recurrence.  There were no deaths, colectomies, or ICU transfers. 

Conclusion: Patients with spinal cord injury and CDI presented with diarrhea or other changes in bowel habits.  Twenty percent of patients were classified as severe, complicated CDI due to hypotenstion, but no patients died or underwent colectomy for CDI.  Metronidazole treatment failure and recurrence were common.        

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Donald M. Dumford, MD1,2, Vineet Bhasker, MD3, Mary Ann Richmond, MD3 and Curtis J. Donskey, MD3, (1)Louis Stokes VA Medical Center, Cleveland, OH, (2)Case Western Reserve University Division of Infectious Diseases, Cleveland, OH, (3)Louis Stokes Cleveland VA Medical Center, Cleveland, OH


D. M. Dumford, None

V. Bhasker, None

M. A. Richmond, None

C. J. Donskey, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.