Clostridium difficile infection in patients with unexplained leukocytosis
Clostridium difficile infection in patients with unexplained leukocytosis
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DOI：
10.1016/s0002-9343(03)00420-0
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发表时间：
2003-11-01
影响因子：
5.9
通讯作者：
Musher, DM
中科院分区：
文献类型：
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作者：
Wanahita, A;Goldsmith, EA;Musher, DM
目得：为了确定在三级医院中不明原因的白细胞增多症的病例中，未被识别的艰难梭菌感染是否是相当大比例的原因。方法：我们前瞻性地确定了60例不明原因的白细胞增多症（白色血细胞计数大于或等于15,000/mm 3）的患者。粪便标本进行C.使用酶免疫吸附测定法测定艰难梭菌毒素。我们比较了阳性或阴性检测结果的患者的临床特征，以及26例住院对照患者谁没有不明原因的leukocytosis.RESULTS：35例（58%）不明原因的白细胞增多患者有C。与对照组的3例（12%）相比，至少一个粪便标本中存在艰难梭菌毒素（P < 0.001）。当白色血细胞计数首次升高时，结肠炎的症状通常是轻微的或不存在的，或者，如果存在，主治医生还没有发现。白细胞增多症在大多数接受甲硝唑治疗的患者中迅速消退。25例（42%）C.艰难梭菌毒素，白细胞增多症也往往解决经验性治疗与甲硝唑，其中一些患者可能有C。结论：在我院不明原因白细胞增多的患者中，大多数是C。艰难感染住院患者不明原因的白细胞增多应及时寻找符合C.艰难梭菌感染和检测C.很难在适当的流行病学背景下，甲硝唑经验性治疗可能有效。(C)2003年，Excerpta Medica Inc.
PURPOSE: To determine whether unrecognized Clostridium difficile infection is responsible for a substantial proportion of cases of unexplained leukocytosis in a tertiary care hospital setting.METHODS: We prospectively identified 60 patients who had unexplained leukocytosis (white blood cell count greater than or equal to15,000/mm(3)). Fecal specimens were tested for C. difficile toxin using an enzyme immunosorbent assay. We compared the clinical features of patients who had positive or negative assay results, as well as of 26 hospitalized control patients who did not have unexplained leukocytosis.RESULTS: Thirty-five (58%) of the patients with unexplained leukocytosis had C. difficile toxin in at least one fecal specimen as compared with 3 (12%) of the controls (P < 0.001). Symptoms of colitis were often mild or absent at the time the white blood cell count was first elevated or, if present, had not been recognized by the attending physicians. Leukocytosis resolved promptly in most patients who were treated with metronidazole. In the 25 patients (42%) who had a negative test for C. difficile toxin, leukocytosis also tended to resolve during empiric therapy with metronidazole; some of these patients may have had C. difficile infection.CONCLUSION: The majority of patients in our hospital who had unexplained leukocytosis had C. difficile infection. Unexplained leukocytosis in hospitalized patients should prompt a search for symptoms and signs consistent with C. difficile infection and a study to detect C. difficile. Empiric therapy with metronidazole may be effective in the appropriate epidemiologic setting. (C) 2003 by Excerpta Medica Inc.