Pseudomembranous colitis: A clinical report from Southern Taiwan

Pseudomembranous colitis is a disease commonly associated with hospitalization. This retrospective study shares the experience of treating pseudomembranous colitis in a Taiwanese hospital. From January 1996 to December 2005, fifty-nine patients, 33 males and 26 females with mean age of 60.9 ± 5.4 years (ranging from 26-84 years-old) were included into this retrospective study. The diagnosis was based on either by sigmoidoscopy or colonoscopy and confirmed by a pathologist and/or by a positive stool culture study. Patients were divided in to 3 groups: group A with mild symptoms and diarrhea 3-5 times per day (n=8); group B having moderate symptoms with diarrhea more than 6 times per day, and stable vital signs but without massive or bloody diarrhea (n=41); group C having severe symptoms and signs of massive, watery or bloody diarrhea, and signs of toxic megacolon, and unstable vital signs implying hypovolemic shock (n=10). Several clinical variables and treatment outcomes were compared. Thirty-five of the patients had prior antibiotics exposure with cephalosporin most commonly associated (n=14). Significant variables were, age > 65 year-old, bloody diarrhea, fever, leukocytosis, and hypoalbuminemia. Twenty-five patients received oral vancomycin treatment, 76% were responders, and 6 were non-responders which included 2 recurrences. Four patients belonged to group C. Twenty-six patients received metronidazole treatment and 88.5% were cured. Three patients were treatment failures (one recurred) and all were cured by shifting to the alternate regimen, but 2 cancer patients with relapses died. The overall mortality rate was 3.4%. We conclude that metronidazole is generally recommended as a first drug of choice in treating pseudomembranous colitis, which also has a cost-benefit. Age > 65 year-old and poor general health statuses are the relevant risk factors for developing into moderate to severe PMC. High suspicion is important in patients with gastrointestinal symptoms specially those with prior exposure to antibiotics or high-risks patients with long-term hospitalization.