Epidemiology, clinical manifestations, and outcome of Clostridium difficile-associated diarrhea.
Epidemiology, clinical manifestations, and outcome of Clostridium difficile-associated diarrhea.
复制标题
艰难梭菌相关性腹泻的流行病学、临床表现和结果。
DOI：
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发表时间：
1994
影响因子：
9.8
通讯作者：
Glatt Ae
中科院分区：
文献类型：
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作者：
A. Anand;B. Bashey;T. Mir;Glatt Ae
目的
艰难梭菌胃肠道疾病是一种重要的医院感染，并与最近的抗生素使用。本研究对C.艰难梭菌相关性腹泻（CDAD）2年。
方法
60例C.粪便中的艰难梭菌肠毒素和腹泻，进行了回顾性分析，在一个615张病床的教学医院。机构抗生素使用和出院医学诊断与研究患者相关。
结果
38名研究患者（53%）有严重或极端的入院症状。只有4人（7%）没有合并症。住院4 wk后CDAD的发生率明显增加（p < 0.05）。没有发现人口或时间聚类。主要临床表现为白细胞增多（60%）、多形核白细胞增多（47%）、脱水（30%）、体重减轻（23%）和少尿（12%）。在这些受试者中，51例（85%）在前6周内使用过头孢曲松和/或头孢他啶;头孢曲松/头孢他啶与单独使用的预期病例数高度显著相关（p < 0.01）。尽管替卡西林/克拉维汀是最常用的抗生素，但没有患者发生CDAD（p < 0.00001）。较高的死亡率与年老体弱的疗养院居民有关。
结论
第三代头孢菌素的使用与CDAD的发生相关;替卡西林/克拉维汀的使用与CDAD的发生无关。与CDAD相关的发病率和死亡率是显著的，在虚弱的老年疗养院患者中更严重，并且更可能发生在住院时间超过4周的患者中。
OBJECTIVE
Clostridium difficile gastrointestinal disease is an important nosocomial infection and is associated with recent antibiotic use. This study evaluated C. difficile-associated diarrhea (CDAD) over a 2-yr period.
METHODS
All 60 patients with C. difficile enterotoxin in their stools, and diarrhea, were retrospectively analyzed at a 615-bed teaching hospital. Institution antibiotic usage and discharge medical diagnoses were correlated with the study patients.
RESULTS
Thirty-eight study patients (53%) had major or extreme admitting symptoms. Only four (7%) had no co-morbid illness. The incidence of CDAD increased significantly (p < 0.05) after 4 wk of hospitalization. No demographic or temporal clustering was discovered. Leukocytosis (60%), leftward polymorphonuclear shift (47%), dehydration (30%), weight loss (23%), and oliguria (12%) were the major clinical findings. Among these subject 51 (85%) had been on ceftriaxone and/or ceftazidime in the preceding 6 wk; ceftriaxone/ceftazidime was highly significantly associated (p < 0.01) with more cases than expected by usage alone. No patient on ticarcillin/clavulanate developed CDAD, although it was the most commonly used antibiotic (p < 0.00001). Higher mortality was associated with older debilitated nursing home residents.
CONCLUSIONS
Third-generation cephalosporin use correlated with the development of CDAD; ticarcillin/clavulanate usage did not. Morbidity and mortality associated with CDAD is significant, is worse in debilitated older nursing home patients, and is more likely to occur in hospitalizations lasting longer than 4 wk.