Antibiotic-Associated Pseudomembranous Colitis: An Epidemiologic Investigation of a Cluster of Cases

Abstract

Ten cases of antibiotic-associated colitis (AAC) were identified at a hospital in Washington, D.C. (USA), from March 17-May 9, 1979. No geographic clustering of cases was found, nor was an association with increased use of antibiotics demonstrated. Exposure to aminoglycosides, cephalosporins and clindamycin was associated with AAC, as was a history of enemas in the 7 days before the onset of illness (P = 0.045). This association was strengthened when gastrointestinal procedures (defined as 3 or more enemas/wk, the insertion of a nasogastric tube for 2 or more days or gastrointestinal surgery) were performed within 7 days of the onset of illness (P = 0.007). Clostridium difficile was not isolated from the hospital environments, nursing personnel or family members of the patients. C. difficile was isolated from stool specimens of 5 (36%) of 14 patients who served as controls.