A High Rate of Alternative Diagnoses in Patients Referred for Presumed Clostridium difficile Infection.
A High Rate of Alternative Diagnoses in Patients Referred for Presumed Clostridium difficile Infection.
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DOI：
10.1097/mcg.0000000000000447
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发表时间：
2016-10
影响因子：
2.9
通讯作者：
Kelly CR
中科院分区：
文献类型：
--
作者：
Jackson M;Olefson S;Machan JT;Kelly CR
我们对转诊至我们中心的一组疑似复发性艰难梭菌感染 (CDI) 患者进行了评估，以确定最终诊断和结果。随着 CDI 发病率的增加，越来越多的患者被诊断出患有复发性 CDI 和其他感染后遗症。将有症状的 CDI 患者与患有其他腹泻症状病因的患者区分开来可能具有挑战性。我们对 2013 年 1 月至 2014 年 6 月期间因复发性 CDI 转诊到我们中心的 117 名患者进行了回顾性审查。收集的数据包括人口统计数据、转诊提供者、既往抗 CDI 治疗以及重要的医疗状况。此外，我们还收集了 CDI 非典型特征的数据以及为调查症状病因而进行的调查。结果包括替代诊断率和转诊来源 CDI 诊断的准确性。平均年龄为 61 岁，70% 为女性。 29 名患者 (25%) 被确定为非 CDI 诊断。最常见的替代诊断包括肠易激综合征（18 名患者：62%）和炎症性肠病（3:10%）。年龄与非 CDI 诊断率呈负相关 (p=0.016)。其余 88 名 (75%) 确诊为 CDI 的患者中，25 名 (28%) 接受单纯药物治疗，63 名 (72%) 接受粪便微生物移植 (FMT)。在因复发性 CDI 转诊到我们中心的患者中，相当大比例的患者并没有患有 CDI，而是有另一种诊断，最常见的是 IBS。替代诊断的比率与年龄成反比。对于具有非典型复发性 CDI 特征的患者，医疗服务提供者应考虑其他腹泻病因。
We evaluated a cohort of patients referred to our center for presumed recurrent Clostridium difficile infection (CDI) to determine final diagnoses and outcomes. As rates of CDI have increased, more patients are diagnosed with recurrent CDI and other sequelae of the infection. Distinguishing symptomatic patients with CDI from those who are colonized with an alternative etiology of diarrheal symptoms may be challenging. We performed a retrospective review of 117 patients referred to our center for recurrent CDI between January 2013 and June 2014. Data collected included demographics, referring provider, previous anti-CDI treatment, and significant medical conditions. Additionally we gathered data on atypical features of CDI and investigations obtained to investigate etiology of symptoms. Outcomes included rates of alternative diagnoses and the accuracy of CDI diagnosis by referral source. The mean age was 61 years and 70% were female. 29 patients (25%) were determined to have a non-CDI diagnosis. Most common alternative diagnoses included irritable bowel syndrome (18 patients: 62%) and inflammatory bowel disease (3:10 %). Age was inversely correlated with rate of non-CDI diagnosis (p=0.016). Of the remaining 88 (75%) patients with a confirmed diagnosis of CDI, 25 (28%) received medical therapy alone and 63 (72%) underwent fecal microbiota transplantation (FMT). Among patients referred to our center for recurrent CDI, a considerable percentage did not have CDI, but rather an alternative diagnosis, most commonly IBS. The rate of alternative diagnosis correlated inversely with age. Providers should consider other etiologies of diarrhea in patients presenting with features atypical of recurrent CDI.