LETTER
Diagnosis of Clostridium difficile Colitis
Stephen Holland, MD
15 September 1996 | Volume 125 Issue 6 | Page 516
TO THE EDITOR:
Some points made in Manabe and colleagues' article on C. difficile colitis [1] deserve to be amplified. The authors evaluated patients in whom the diagnosis of C. difficile colitis was entertained rather than all patients, or even just patients with diarrhea. Would the conclusions remain the same for patients in whom it was not clear whether the diagnosis of C. difficile colitis should be considered?
Perhaps the patients in whom the duration of diarrhea was longer might be a subgroup worth analyzing. The results of Manabe and colleagues' study were summarized as significant odds ratios for the following four variables: leukocyte positive by lactoferrin assay, positive for fecal leukocytes by Gram stain, recent cephalosporin use, and presence of semiformed stool. It is not immediately clear how sensitive and specific the presence of positive findings for these variables is, alone or in combination, for the diagnosis of C. difficile colitis.
Finally, the statistical analysis included stepwise multiple regression. I am surprised that leukocytes positive by lactoferrin and by Gram stain were both shown to be statistically significant; it would seem that the two should not be independent variables. Which independent variables might the two tests be measuring?
|
Author and Article Information
|
|---|
University of Illinois at Peoria, Peoria, IL 61602
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.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
REFERENCE
Article
