Clostridium difficile Colitis: Reduced Time to Diagnosis in a Community-Based Outpatient Setting Between 1997 and 2004.

OBJECTIVE We studied antibiotic use prior to the onset of Clostridium difficile colitis (CDC) and time interval between onset of gastrointestinal symptoms and diagnosis for two historical time periods with separate comparisons for inpatients and outpatients to determine whether time to diagnosis had decreased and whether previous metronidazole use is associated with CDC. METHOD We performed a retrospective chart review of adult patients (those 18 years or older) with positive findings on Clostridium difficile (CD) stool toxin tests performed at a Kaiser Permanente Southern California medical center. Independent assessments were compared for 1997-1998 and for 2004 time periods. These assessments used similar enrollment and exclusion criterion. Study populations were evaluated for previous antibiotic use and to determine time from clinical presentation of symptoms to diagnosis of CDC during each of the time periods, with assessments made separately for inpatients and outpatients. RESULTS Findings showed a reduction in the average time from symptom presentation to diagnosis among outpatients with CDC from 17 days in the first time period (1997-1998) to ten days during the second time period (2004). No significant difference in the average time from symptom presentation to diagnosis of CDC was evident among inpatients (5.33 days for 1997-1998 and 6.00 days for 2004). Multiple antibiotic use prior to diagnosis of CDC was evident among both outpatients and inpatients in this study. Metronidazole had been used prior to the onset of CDC in approximately 15% of cases. CONCLUSION The time from symptom onset to a CDC diagnosis decreased by seven days between the 1997-1998 and 2004 time periods among outpatients in this health care setting. Previous metronidazole use appeared to be associated with some cases of CDC.