Diagnosis of Clostridium difficile-associated enterocolitis in Sweden. Laboratory and epidemiological aspects.

Over a 32-week period 1979, 256 fecal samples from 132 patients with antibiotic-associated enterocolitis were analyzed for the presence of C. difficile bacteria and/or toxin. The toxin test was positive in 35 patients (27%) and the bacterium was present in 14 patients (11%). Seventy-three patients with enterocolitis were investigated with regard to age, sex, antibiotic therapy, and clinical symptoms by analysis of their records. A positive toxin titre had an apparent predictive value of 69% for pseudomembranous enterocolitis or other serious colitis, while a negative titre had a 74% predictability for a non-serious disease. Many different types of antibiotics were found to be associated with enterocolitis. Incubation times of more than two weeks from the onset of the antibiotic therapy were noted in 12% of the cases. Vancomycin was administered orally in the treatment of 17 patients, with good results in all but two cases. Two case reports are presented in which relapses occurred upon renewed antibiotic treatment. It is concluded that routine diagnosis of C. difficile in faeces, especially through direct detection of toxin, may be useful in the clinical management of antibiotic-associated enterocolitis.