Leukocytosis as a harbinger and surrogate marker of Clostridium difficile infection in hospitalized patients with diarrhea
Leukocytosis as a harbinger and surrogate marker of Clostridium difficile infection in hospitalized patients with diarrhea
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DOI：
10.1111/j.1572-0241.2000.03284.x
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发表时间：
2000-11-01
影响因子：
9.8
通讯作者：
Triadafilopoulos, G
中科院分区：
文献类型：
--
作者：
Bulusu, M;Narayan, S;Triadafilopoulos, G
目标：艰难梭菌是腹泻相关性腹泻和伪膜性结肠炎的病原体，并且是医院内腹泻的主要原因。本研究的目的是探讨白细胞增多是否可以作为C.方法：我们回顾性研究了70例住院患者的病历，这些患者表现为不同严重程度的腹泻，并接受了肠道病原体的粪便检查，包括C。很难我们特别记录了两组患者的白色血细胞计数和白细胞增多的模式和严重程度。结果：白细胞增多常见于C.艰难梭菌阳性患者，与C.艰难梭菌阴性患者（平均15，800/mm（3）vs 7700/mm（3），p < 0.01）。35 C的评论difficile阳性患者显示三种模式：模式A）突然WBC增加与提示C的症状发作一致。模式B）在C.艰难梭菌相关腹泻并作为感染的先兆;以及模式C）作为C.艰难感染所有病例经甲硝唑治疗后，症状改善，白细胞计数恢复正常。在先前或同时接受抗生素治疗的住院患者中，在鉴别诊断突然发作的白细胞增多症时应考虑艰难梭菌。这样做可能会减少对其他病因进行昂贵和耗时的测试的需要。(C)2000年，我Cell.胃肠病学）。
OBJECTIVES: Clostridium difficile is the etiological agent of antibiotic-associated diarrhea and pseudomembranous colitis and is a leading cause of nosocomial diarrhea. The objective of the study was to examine if leukocytosis could be a harbinger and surrogate marker of C. difficile infection in hospitalized patients.METHODS: We retrospectively examined the medical records of 70 hospitalized patients who presented with diarrhea of variable severity and who underwent stool examination for enteric pathogens, including C. difficile. We specifically recorded the white blood cell count and the pattern and severity of leukocytosis in two groups of patients-those who were C. difficile-positive and those who were negative.RESULTS: Leukocytosis was common in C. difficile-positive patients, compared to in C. difficile-negative patients (mean 15,800/mm(3) vs 7700/mm(3), p < 0.01). Review of the 35 C. difficile-positive patients revealed three patterns: Pattern A) sudden WBC increase coinciding with the onset of symptoms suggestive of C. difficile; Pattern B) unexplained leukocytosis preceding the appearance of C. difficile-related diarrhea and serving as a harbinger of the infection; and Pattern C) worsening of pre-existing leukocytosis as a surrogate marker of C. difficile infection. Treatment with metronidazole led to amelioration of symptoms and normalization of the leukocyte count in all cases.CONCLUSIONS: Infection with C. difficile should be considered in the differential diagnosis of sudden onset of leukocytosis in hospitalized patients previously or concurrently treated with antibiotics. Doing so may obviate the need for expensive and time-consuming tests fur other etiologies. (C) 2000 by Am. Cell. of Gastroenterology).