Poor Nutritional Status may Predispose Clostridium difficile-Associated Diarrhea Patients to Higher Incidence of Recurrence

Abstract

  An important problem in the treatment of Clostridium difficile-associated diarrhea (CDAD) is the high rate of recurrence caused by the immune response of the host. Hypoalbuminemia is known to increase the risk of recurrence. However, the underlying mechanisms of CDAD recurrence associated with the patients' nutritional status remains unclear. In this study, we sought to investigate how nutritional status can affect the recurrence of CDAD. Thirteen consecutive patients who suffered CDAD recurrence between July 2006 and February 2008 (rec group, 〔mean±SEM〕 80±3 yrs) were compared with 13 patients without recurrence (control, 81±3 yrs). Both groups were treated with standard antibiotic therapy (VCM and/or MTZ). There were no significant differences at the onset of the first episode of CDAD between the two groups in respect to nutritional parameters including serum albumin, cholinesterase, total cholesterol, and energy sufficiency. However, the rec group showed significantly lower serum albumin and cholinesterase at recurrence compared to the first episode (albumin: 2.9±0.2 vs. 2.5±0.1 g/dL, p<0.05; choline esterase: 134±17 vs. 103±13 IU/L, p<0.05). The control group did not show significant change in these parameters in the 30 days after the first episode. Thus, we conclude that poor nutritional status may predispose patients with CDAD to recurrence. Future studies on how poor nutritional status can affect the patients' immune system are needed.