[Skip to Content]
[Skip to Content Landing]
January 1986

Clostridium difficile—Associated Diarrhea and Colitis in Adults: A Prospective Case-Controlled Epidemiologic Study

Author Affiliations

From the Departments of Medicine (Drs Gerding, Peterson, and Gebhard), Surgery (Ms Olson and Drs Teasley, Schwartz, and Lee), and Laboratory Medicine (Drs Gerding and Peterson), Veterans Administration Medical Center and University of Minnesota Medical School, Minneapolis.

Arch Intern Med. 1986;146(1):95-100. doi:10.1001/archinte.1986.00360130117016

In a one-year period, 149 adult cases of Clostridium difficile—associated diarrhea and colitis were compared with 148 diarrhea-free controls. Eighty-seven percent were nosocomial and 75% were on surgical services. Endoscopy revealed pseudomembranes in 51% of the 109 cases in which stool cytotoxin was present, compared with 11% of the 40 cases that were culture-positive but cytotoxin-negative. Cases diagnosed only by stool culture showed essentially no differences from controls, 21% of whom had asymptomatic stool colonization. We estimate that only 20% of these cases had diarrhea due to C difficile. Compared with controls, cases diagnosed by the presence of cytotoxin or pseudomembranes were found to have been hospitalized longer at diarrhea onset, to have had more antecedent infections, and to have received clindamycin, multiple antimicrobials, and therapeutic antimicrobials more often than controls, but controls received prophylactic antimicrobials more frequently than cases. Cultures of the environment, patients, and personnel failed to detect a mechanism of acquisition.

(Arch Intern Med 1986;146:95-100)

George WL, Sutter VL, Goldstein EJC, et al:  Aetiology of antimicrobial-agent-associated colitis.  Lancet 1979;1:802-803.
Bartlett JG, Chang TW, Gurwith M, et al:  Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia.  N Engl J Med 1978;298:531-534.Crossref
Rifkin GD, Fekety FR, Silva J Jr, et al:  Antibiotic-induced colitis: Implication of a toxin neutralized by Clostridium sordellii antitoxin.  Lancet 1977;2:1103-1106.Crossref
Larson HE, Price AB:  Pseudomembranous colitis: Presence of clostridial toxin.  Lancet 1977;2:1312-1314.Crossref
Bartlett JG:  Antibiotic-associated pseudomembranous colitis.  Rev Infect Dis 1979;1:530-539.Crossref
Kabins SA, Spira TJ:  Outbreak of clindamycin-associated colitis.  Ann Intern Med 1975;83:830-831.Crossref
Kim K-H, Fekety R, Batts DH, et al:  Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis.  J Infect Dis 1981;143:42-50.Crossref
Pierce PF Jr, Wilson R, Silva J Jr, et al:  Antibiotic-associated pseudomembranous colitis: An epidemiologic investigation of a cluster of cases.  J Infect Dis 1982;145:269-274.Crossref
Burdon DW:  Clostridium difficile: The epidemiology and prevention of hospital acquired infection.  Infection 1982;10:203-204.Crossref
Fekety R, Kim K-H, Brown D, et al:  Epidemiology of antibiotic-associated colitis: Isolation of Clostridium difficile from the hospital environment.  Am J Med 1981;70:906-908.Crossref
Mulligan ME, Rolfe RD, Finegold SM, et al:  Contamination of a hospital environment by Clostridium difficile.  Curr Microbiol 1979;3:173-179.Crossref
Savage AM, Alford RH:  Nosocomial spread of Clostridium difficile.  Infect Control 1983;4:31-33.
George WL, Sutter VL, Citron D, et al:  Selective and differential medium for isolation of Clostridium difficile.  J Clin Microbiol 1979;9:214-219.
Holdeman LV, Cato EP, Moore WEC:  Anaerobe Laboratory Manual , ed 4. Blacksberg, Va, Virginia Polytechnic Institute and State University, 1977.
Shanholtzer CJ, Peterson LR, Olson MM, et al:  Prospective study of Gram stain stool smears in diagnosis of Clostridium difficile.  J Clin Microbiol 1983;17:906-908.
Wilson KH, Kennedy MJ, Fekety R:  Use of sodium taurocholate to enhance spore recovery on a medium selective for Clostridium difficile.  J Clin Microbiol 1982;15:443-446.
Peavy JV, Dyal WW:  Analytical Statistics . US Dept of Health, Education, and Welfare publication. Atlanta, Centers for Disease Control.
Tedesco FJ, Barton RW, Alpers DH:  Clindamycin-associated colitis.  Ann Intern Med 1974;81:429-433.Crossref
Viscidi R, Willey S, Bartlett JG:  Isolation rates and toxigenic potential of Clostridium difficile isolated from various patient populations.  Gastroenterology 1981;81:5-9.
George WL, Rolfe RD, Finegold SM:  Clostridium difficile and its cytotoxin in feces of patients with antimicrobial agent—associated diarrhea and miscellaneous conditions.  J Clin Microbiol 1982;15:1049-1053.
Tedesco FJ:  Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination.  Gastroenterology 1979;77: 295-297.
Teasley DG, Gerding DN, Olson MM, et al:  Prospective randomized trial of metronidazole versus vancomycin for the treatment of Clostridium difficile—associated diarrhea and colitis.  Lancet 1983;2:1043-1046.Crossref
Mogg GAG, Keighley MRB, Burdon DW, et al:  Antibiotic-associated colitis: A review of 66 cases.  Br J Surg 1979;66:738-742.Crossref
Larson HE, Barclay FE, Honour P, et al:  Epidemiology of Clostridium difficile in infants.  J Infect Dis 1982;146:727-733.Crossref
Oishi JS, Mulligan ME, Finegold SM:  Failure to detect Clostridium difficile in foods.  J Infect Dis 1983;148:360.Crossref
Mulligan ME:  Epidemiology of Clostridium difficile—induced intestinal disease.  Rev Infect Dis 1984;6( (suppl 1) ):222-228.Crossref