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Recurrent Clostridium Difficile Disease: Epidemiology and Clinical Characteristics

Published online by Cambridge University Press:  02 January 2015

Lynne V. McFarland*
Department of Medicinal Chemistry, School of Pharmacy, Seattle, Washington Department of Medicine, School of Medicine, University of Washington
Christina M. Surawicz
Division of Gastroenterology, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
Moshe Rubin
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
Robert Fekety
Division of Infectious Diseases, Department of Internal Disease, University of Michigan, Ann Arbor, Michigan
Gary W. Elmer
Department of Medicinal Chemistry, School of Pharmacy, Seattle, Washington
Richard N. Greenberg
Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, Kentucky Lexington Veterans' Affairs Medical Center, Lexington, Kentucky
1910 Fairview Ave E, #208, Seattle, WA 98102



To describe the epidemiology, diagnosis, risk factors, patient impact, and treatment strategies for recurrent Clostridium difficile-associated disease (CDAD).


Data were collected as part of a blinded, placebo-controlled clinical trial testing a new combination treatment for recurrent CDAD. Retrospective data regarding prior CDAD episodes were collected from interviews and medical-chart review. Prospective data on the current CDAD episode, risk factors, and recurrence rates were collected during a 2-month follow-up.


National referral study.


Patients with recurrent CDAD.


Treatment with a 10-day course of low-dose (500 mg/d) or high-dose (2 g/d) vancomycin or metronidazole (1 g/d).


Recurrent CDAD was found to have a lengthy course involving multiple episodes of diarrhea, abdominal cramping, nausea, and fever. CDAD may recur over several years despite frequent treatment with antibiotics. Recurrence rates were similar regardless of the choice or dose of antibiotic. Recurrent CDAD is not a trivial disease: patients may have multiple episodes (as many as 14), may require hospitalization, and the mean lifetime cost of direct medical care was $10,970 per patient. Fortunately, the disease does not become progressively more severe as the number of episodes increase. Two risk factors predictive for recurrent CDAD were found: increasing age and a decreased quality-of-life score at enrollment.


Recurrent CDAD is a persistent disease that may result in prolonged hospital stays, additional medical costs, and rare serious complications.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 1999

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