Clostridum difficile-associated diarrtiea is a terminal event in HIV-infected patients

Diarrhea is common among hospitalized patients and is often a complication of antibiotic therapy. We have recently noted a marked clustering of cases of C. difficile-associated diarrhea (CDAD) In our hospital. In the course of that investigation, we found CDAD had a remarkable association with death among HIV-infected patients. We reviewed all patients with a laboratory-confirmed diagnosis (stool cytotoxin assay positive) of CDAD over a 24 month period from 1/94 -12/95. Controls were patients with diarrhea on the same ward as a case patient (± 30 days) but with negative cytotoxin assays. We selected one control for every two patients. Prior antibiotic therapy, laboratory values, diagnoses, and patient outcomes were reviewed. We studied 312 patients with diarrhea; 216 had CDAD, 96 were controls and 58 patients were HIV (+). CDAD was diagnosed in 176 of 253 (70%) HIV (-) patients and 39 of 58 (67%) HIV (+) patients. Overall, 185 of 312 (59%) patients died, including 105 of 216 (49%) with CDAD and 31 of 96 (32%) controls. However, 34 of 39 (87%) patients were HIV (+) and had CDAD compared to 9 of 19 (47%) patients who were HIV (+) but did not have CDAD (p=.01). Patents with HIV and CDAD were younger (45 vs 68 yrs), had higher SGOT values (85 vs 40 IU/dl), lower hemoglobins (9.5 vs 10.8 g/dl) and lower WBCs (5.4 vs 11.2 × 10⁹/I) than other CDAD patients. Clustering of cases was particularly evident in HIV patients; 36 of 39 cases occurred on the HIV unit within 21 days of at least one other case. CDAD is a potentially lethal nosocomial infection in HIV patients which may be promoted by aggressive antibiotic treatment and congregating cases on special units.