Recurrent Clostridium difficile disease:: Epidemiology and clinical characteristics
Recurrent Clostridium difficile disease:: Epidemiology and clinical characteristics
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DOI：
10.1086/501553
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发表时间：
1999-01-01
影响因子：
4.5
通讯作者：
Greenberg, RN
中科院分区：
文献类型：
--
作者：
McFarland, LV;Surawicz, CM;Greenberg, RN
目的：描述复发性艰难梭菌相关性疾病（CDAD）的流行病学、诊断、危险因素、患者影响和治疗策略。设计：收集数据作为盲法、安慰剂对照临床试验的一部分，测试一种新的复发性CDAD联合治疗。通过访谈和病历审查收集了关于既往CDAD发作的回顾性数据。在2个月的随访期间收集了关于当前CDAD发作、危险因素和复发率的前瞻性数据。设置：国家转诊研究。参与者：复发性CDAD患者。干预：用10天疗程的低剂量（500 mg/d）或大剂量（2 g/d）万古霉素或甲硝唑（1 g/d）。发现复发性CDAD具有漫长的病程，包括多次腹泻、腹部绞痛、恶心和发热。尽管经常使用抗生素治疗，CDAD仍可能在数年内复发。无论抗生素的选择或剂量如何，复发率相似。复发性CDAD不是一种简单的疾病：患者可能会多次发作，最多可达14次，可能需要住院治疗，每位患者的直接医疗护理的平均终身费用为10，970美元。幸运的是，这种疾病不会随着发作次数的增加而变得越来越严重。CDAD复发的两个危险因素是：年龄增加和入组时生活质量评分降低。结论：CDAD复发是一种持续性疾病，可能导致住院时间延长、额外的医疗费用和罕见的严重并发症。
OBJECTIVE: To describe the epidemiology, diagnosis, risk factors, patient impact, and treatment strategies for recurrent Clostridium difficile-associated disease (CDAD).DESIGN: Data were collected as part of a blinded, placebo-controlled clinical trial testing a new combination treatment for recurrent: CDAD. Retrospective data regarding prior CDAD episodes were collected from interviews and medical-chart review. Prospective data on the current CDAD episode, risk factors, and recurrence rates were collected during a 2-month follow-up.SETTINGS: National referral study.PARTICIPANTS: Patients with recurrent CDAD.INTERVENTIONS: Treatment with a 10-day course of low-dose (500 mg/d or high-dose (2 g/d) vancomycin or metronidazole (1 g/d).RESULTS: Recurrent CDAD was found to have a lengthy course involving multiple episodes of diarrhea, abdominal cramping, nausea, and fever. CDAD may recur over several years despite frequent treatment with antibiotics. Recurrence rates were similar regardless of the choice or dose of antibiotic. Recurrent CDAD is not a trivial disease: patients may have multiple episodes las many as 14), may require hospitalization, and the mean lifetime cost of direct medical care was $10,970 per patient Fortunately, the disease does not become progressively more severe as the number of episodes increase. Two risk factors predictive for recurrent CDAD were found: increasing age and a decreased quality-of-life score at enrollmentCONCLUSIONS: Recurrent CDAD is a persistent disease that may result in prolonged hospital stays, additional medical costs, and rare serious complications.