A ROLE FOR COLONIC STASIS IN THE PATHOGENESIS OF DISEASE RELATED TO CLOSTRIDIUM-DIFFICILE
A ROLE FOR COLONIC STASIS IN THE PATHOGENESIS OF DISEASE RELATED TO CLOSTRIDIUM-DIFFICILE
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DOI：
10.1007/bf02555349
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发表时间：
1986-12-01
影响因子：
3.9
通讯作者：
FAZIO, VW
中科院分区：
文献类型：
--
作者：
CHURCH, JM;FAZIO, VW
回顾了1982年至1984年133例粪便艰难梭菌培养或毒素检测阳性的连续患者（65例男性，68例女性;年龄范围15个月至88岁;中位数57岁）的记录，以评估该疾病在大型医院的模式，并检查有风险的患者类型。所有患者均有腹泻和/或血便（分别为121例和36例）。不太具体的症状是常见的。大多数患者暴露于多种抗生素，但在仅接受一种药物的患者中，头孢菌素类最常见（21/43）。19例患者接受了癌症化疗。C.艰难梭菌毒素检测阳性106例，培养阳性74例，假膜6例。治疗包括停止单独的抗生素治疗（86%的反应），口服万古霉素（88%的反应）或甲硝唑（82%的反应）。由于C. 31例病例中有3例为艰难性结肠炎。许多患者正在接受药物治疗或患有与粪便淤滞相关的其他疾病。有许多间接证据支持粪便瘀滞在C.艰难病接受抗生素治疗的易患结肠淤滞症的患者应被认为有患这种疾病的风险，应采取预防措施减少粪便通过时间。
: The records of 133 consecutive patients (65 men, 68 women; age range, 15 months to 88 years; median, 57 years) with either a positive Clostridium difficile stool culture or toxin assay from 1982 to 1984 were reviewed in order to assess the pattern of this disease in a large hospital and to examine the type of patient at risk. All patients had diarrhea and or bloody stools (121 and 36, respectively). Less specific symptoms were common. Most patients had been exposed to multiple antibiotics, but of those who had received only one agent, cephalosporins were most common (21/43). Nineteen patients had cancer chemotherapy. C. difficile toxin assay was positive in 106, culture was positive in 74, and pseudomembranes were seen in six of the 39 patients who underwent endoscopy. Treatment consisted of stopping antibiotic therapy alone (86 percent response), oral vancomycin (88 percent response) or metronidazole (82 percent response). The overall mortality rate was 23 percent, due to C. difficile colitis in three of 31 cases. Many patients were receiving medications or had other diseases associated with fecal stasis. There is much circumstantial evidence to support a role for fecal stasis in the pathogenesis of C. difficile disease. Patients predisposed to colonic stasis who are receiving antibiotics should be considered at risk for this disease, and preventative measures should be taken to decrease stool transit times.