Abstract

Background/Aims
Unconsciousness can create problems in diagnosing and treating pseudomembranous colitis (PMC). While early recognition of clostridium difficile infection and immediate medical therapy can lead to a good prognosis, delayed diagnosis can lead to complex, recurrent and even fatal PMC. The relationships between endoscopic clinical features and unconsciousness are not well documented. The aim of this study was to determine the relationships between PMC endoscopic clinical features and the level of consciousness. Methods: Fifty three patients with confirmed PMC during the past 2 years were analyzed retrospectively. Patients were categorized as being in either a conscious state (CS) (i.e. alert) or an unconscious state (US) (i.e. drowsy, stupor, semicoma or coma). Endoscopic patterns of pseudomembranous plaques were classified as grade I=only friability or erosion without plaque, grade II=granular plaque, grade III=nodular plaque, or grade IV=confluent plaque. Clinical features including diagnostic interval (from initial prescription of antibiotic to confirming PMC), endoscopic severity, treatment method, treatment duration and prognosis were compared in between CS and US groups. Results: Mean patient age was 65.7⁑14.9 (male 47.2%, female 52.8%). The overall diagnostic interval was 9.37⁑4.35 days. Frequently causative antibiotics were cephalosporin (52.8%, 28/53), clindamycin (13.2%, 7/53) and imipenam (9.4%, 5/53). Of the 53 patients, 60.4% (32/53) were categorized as CS, and 39.6% (21/53) as US. In terms of pseudomembranous plaque endoscopic patterns, 18.9% (10/53) were grade I, 28.3% (15/53) were grade II, 32.1% (17/53) were grade III, and 20.8% (11/53) were grade IV. Treatment involved oral administration only. The overall complete treatment rate was 94.3% (50/53). The overall recurrence rate was 5.7% (3/53), and of these one patient died, and two patients were successfully managed by re-treatment. One recurrent and the fatal case occurred in the US group. The US group was positively correlated with longer diagnostic interval, and showed more severe endoscopic features and longer treatment duration compared to the CS group (p＜0.05). Conclusions: Endoscopic and clinical features were more serious in unconscious PMC patients. Compared to conscious patients, unconscious patients being administrated antibiotics must be given greater attention in terms of early diagnosis and successful management of PMC. (Intestinal Research 2006;4:101-105)

• Keywords: Pseudomembranous colitis, Unconsciousness