Antibiotic‐associated colitis caused by Clostridium difficile: relapse and risk factors
Antibiotic‐associated colitis caused by Clostridium difficile: relapse and risk factors
复制标题
艰难梭菌引起的抗生素相关性结肠炎：复发和危险因素
DOI：
--
复制
发表时间：
1986
影响因子：
11.4
通讯作者：
M. McDonald
中科院分区：
文献类型：
--
作者：
G. Young;N. Bayley;P. Ward;D. St. John;M. McDonald
复发是艰难梭菌引起的抗生素相关性结肠炎的常见后遗症。有人认为，Cl。尽管治疗后症状消退，但艰难梭菌可能持续存在于粪便中，这可能导致复发。我们的研究旨在确定易复发的因素，并确定是否延长治疗以清除Cl。粪便中的艰难梭菌可能会防止复发。在60名连续患者中，36名患有更严重疾病的患者需要治疗。继续用万古霉素或杆菌肽治疗，直至粪便细胞毒素检查结果为阴性，Cl。艰难梭菌不能再培养（培养的灵敏度为10-100个微生物/mL）。这在35名患者中实现，然后随访一个月。10例（28.6%）治疗后症状复发，而Cl.艰难梭菌再次出现在另外7名患者（20%）的粪便中，没有腹泻复发。复发者与未复发者相比，年龄（复发者67.3 ± 5.5岁与51.6 ± 4.4岁; P < 0.025，x ± SE）和近期腹部手术史（复发者59%与17%; P < 0.05）有显著差异。虽然那些复发的人更经常接受多种抗生素治疗，但这并不具有统计学意义。复发患者的病情并没有更严重，从这些患者身上清除病原体也没有更困难。24例未经治疗的患者没有出现症状复发。继续治疗直至Cl。粪便中明显没有艰难梭菌，费用昂贵且不能防止复发。老年患者和最近接受腹部手术的患者更容易复发。
Relapse is a common sequel of antibiotic‐associated colitis due to Clostridium difficile. It has been suggested that Cl. difficile may persist in the stools in spite of the resolution of symptoms after treatment and this may cause the relapse. Our study was designed to define the factors that predispose to relapse and to determine if prolonging treatment to clear Cl. difficile from the stools might prevent relapse. Of 60 consecutive patients, 36 with more severe disease required treatment. Treatment with either vancomycin or bacitracin was continued until the results of the examination of stools for cytotoxin became negative and Cl. difficile could no longer be cultured (sensitivity of culture was 10–100 organisms/mL). This was achieved in 35 patients who were then followed for one month. Symptoms reappeared in 10 (28.6%) of the treated patients while Cl. difficile reappeared in the stools of an additional seven patients (20%) without the recurrence of diarrhoea. On comparing those who relapsed with those who did not, the age (67.3 ± 5.5 years in those who relapsed compared with 51.6 ± 4.4 years; P < 0.025, x¯ ± SE) and a history of recent abdominal surgery (59% of those who relapsed compared with 17%; P < 0.05) were significantly different. Although those who relapsed had received therapy with multiple antibiotic agents more often, this was not statistically significant. Disease was not more severe in patients who relapsed, nor was it more difficult to clear the pathogen from these patients. The 24 untreated patients did not suffer symptomatic relapse. Continuation of treatment until Cl. difficile apparently is absent from the stools is expensive and does not prevent relapse. Elderly patients and those who have recently undergone abdominal sugery are more likely to suffer a relapse.