SEVERE CLOSTRIDIUM-DIFFICILE COLITIS
SEVERE CLOSTRIDIUM-DIFFICILE COLITIS
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DOI：
10.1007/bf02054220
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发表时间：
1995-04-01
影响因子：
3.9
通讯作者：
KENT, KC
中科院分区：
文献类型：
--
作者：
RUBIN, MS;BODENSTEIN, LE;KENT, KC
目的：艰难梭菌结肠炎相关的死亡报告和这种感染流行率的急剧增加促使对发展为更具侵袭性的这种疾病的患者进行研究。方法：在38个月的时间里，我们机构的710名患者发生了艰难梭菌结肠炎。这些患者中有21人（3%）要么需要进入重症监护病房，要么因感染而死亡。进行了一项回顾性病例对照研究，将这些被认为患有严重艰难梭菌结肠炎的患者与其余病情较轻的患者进行比较。结果：易患严重艰难梭菌性结肠炎的因素包括合并恶性肿瘤、慢性阻塞性肺疾病、免疫抑制和抗蠕动药物、肾功能衰竭和克林霉素的使用（均P < 0.05）。严重艰难梭菌性结肠炎患者更容易出现腹痛、压痛和腹胀、腹膜炎、血浓缩（bbb50分）、低白蛋白血症（25,000例）；90例被认为是不良或不合适的手术候选者。只有剩下的8名患者有可能从手术中恢复，并有长期生存的希望。其中，7例患者未行结肠切除术，6例患者存活，1例患者行结肠切除术，但未存活。结论：严重艰难梭菌性结肠炎患者可以很容易地识别。他们通常有共存的疾病，无法进行手术。在这个系列中，21例严重艰难梭菌患者中只有1例可能从积极的手术方法中受益。
PURPOSE: Reports of fatality related to Clostridium difficile colitis and a sharp increase in prevalence of this infection prompted a study of patients who develop a more aggressive form of this disease. METHODS: Over 38 months, 710 patients at our institution developed C. difficile colitis. Twenty-one (3 percent) of these patients either required intensive care unit admission or died as a result of their infection. A retrospective, case-controlled study was undertaken to compare these patients, who were considered to have severe C. difficile colitis, with the remaining patients with milder disease. RESULTS: Factors that predisposed to the development of severe C. difficile colitis included intercurrent malignancy, chronic obstructive pulmonary disease, immunosuppressive and antiperistaltic medications, renal failure, and administration of clindamycin (P < 0.05 for all). Patients with severe C. difficile colitis were more likely to have abdominal pain, tenderness and distention, peritonitis, hemoconcentration (>5 points), hypoalbuminemia (25,000; 90 were considered poor or inappropriate surgical candidates. Only the remaining eight patients could have potentially recovered from operation with hope for long-term survival. Of these, seven were treated without colonic resection, and six of the seven survived, whereas one patient underwent colectomy and did not survive. CONCLUSIONS: Patients with severe C. difficile colitis can be readily identified. Often they have coexisting illness that precludes operation. In this series, only 1 of 21 patients with severe C, difficile might have benefited from an aggressive surgical approach.