Outcome of colectomy for Clostridium difficile colitis:: a plea for early surgical management
Outcome of colectomy for Clostridium difficile colitis:: a plea for early surgical management
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DOI：
10.1016/j.amjsurg.2007.11.017
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发表时间：
2008-09-01
影响因子：
3
通讯作者：
Berger, David
中科院分区：
文献类型：
--
作者：
Hall, Jason F.;Berger, David
背景：暴发性艰难梭状芽孢杆菌结肠炎是一种常见的医院感染，发生的频率越来越高。方法：回顾1998-2006年间连续3 237例艰难梭菌细胞毒素阳性的粪便标本。手术当天收集常用的手术干预指标。对大肠次全切除存活患者和死亡患者的术前特征进行比较。结果：36例患者接受了结肠切除术。23例患者(%)活着出院。术前插管和血管加压剂需求是住院死亡率的危险因素(优势比[OR]，7.15；95%可信区间[95%CI])。OR分别为1.28~39.8和6.0；CI分别为1.08~33)。最近接受手术的患者的住院死亡率较低(OR，0.11：95%CI，0.02-0.52)。结论：暴发性艰难梭菌结肠炎与高死亡率有关。出现血管加压药需求或需要插管是不祥的征兆，应导致迅速的手术干预。(C)2008 Elsevier Inc.保留所有权利。
BACKGROUND: Fulminant Clostridium difficile colitis is a common nosocomial infection that occurs with increasing frequency. METHODS: A total of 3,237 consecutive cases of C difficile cytotoxin-positive stool samples from 1998 to 2006 were reviewed. Commonly referenced indicators for surgical intervention were gathered on the day of surgery. The preoperative characteristics of patients surviving subtotal colectomy were compared with those who did not survive. RESULTS: Thirty-six patients underwent colectomy. Twenty-three patients (64%) were discharged from the hospital alive. Preoperative intubation and vasopressor requirement were risk factors for in-hospital mortality (odds ratio [OR], 7.15; 95% confidence interval [95% CI]. 1.28-39.8 and OR, 6.0; CI, 1.08-33, respectively). Patients who had a recent surgical procedure had a lower in-hospital mortality rate (OR,.11: 95% CI,.02-.52). CONCLUSIONS: Fulminant C difficile colitis is associated with a high mortality rate. Development of a vasopressor requirement or need for intubation are ominous signs and should lead to rapid surgical intervention. (c) 2008 Elsevier Inc. All rights reserved.