LETTER
Diagnosis of Clostridium difficile Colitis
Anil Minocha, MD, and
Robert J. Richards, MD
15 September 1996 | Volume 125 Issue 6 | Page 515
TO THE EDITOR:
Manabe and colleagues [1] have provided valuable guidelines for diagnosing C. difficile colitis in hospitalized patients. The study group was defined as patients who had C. difficile toxin as shown by enzyme-linked immunoassay or cytotoxin tissue culture assay. Although this definition of C. difficile colitis is adequate for clinical purposes, we should remember that the presence of C. difficile toxin is not always associated with C. difficile colitis. On the basis of a positive cytotoxin tissue culture assay, C. difficile was present in 34 of 268 patients (12.7%) in Manabe and colleagues' study. This prevalence is similar to that of C. difficile positivity seen in 5% to 15% of adults who were treated with antimicrobial agents but did not have related diarrhea [2]. Thus, it would be interesting to know the prevalence of C. difficile positivity in the patients in Manabe and coworkers' study who received antibiotics but did not have diarrhea.
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Author and Article Information
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University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126
1. Manabe YC, Vinetz JM, Moore RD, Merz C, Charache P, Bartlett JG.Clostridium difficile colitis: an efficient clinical approach to diagnosis. Ann Intern Med. 1995; 123:835-40.
2. Bartlett JG. Pseudomembranous enterocolitis and antibiotic-associated colitis. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. Philadelphia: WB Saunders; 1993:1174-89.
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