Crabtree T D, Pelletier S J, Gleason T G, Pruett T L, Sawyer R G
University of Virginia Department of Surgery, Charlottesville, USA.
Am Surg. 1999 Jun;65(6):507-11; discussion 511-2.
Clostridium difficile-associated diarrhea (CDAD) remains a significant problem in surgical patients. To address this, we prospectively studied all episodes of treated CDAD in surgical inpatients at the University of Virginia hospital from December 1996 through March 1998. CDAD accounted for 3.2 per cent (32) of 1000 total infections. Compared with a randomly selected control group with other nosocomial infections, patients with CDAD had a longer period from the time of admission to diagnosis of infection (19 +/- 4 versus 9 +/- 1; P = 0.01), were more likely to be female (66% versus 37%; P = 0.009), and had a higher overall crude mortality (31% versus 11%; P = 0.01), although there were no deaths directly attributable to CDAD. Ciprofloxacin (19%) and cefoxitin (16%) were the most common individual antibiotics prescribed before the diagnosis of CDAD. The average time from completion of antibiotic therapy to diagnosis of CDAD was 7 +/- 2 days (range, 0-58). Sixteen per cent (5 of 32) developed CDAD after administration of prophylactic perioperative antibiotics only. The high crude mortality rate associated with CDAD suggests that this may be a significant predictor of poor outcome among infected surgical patients. Antibiotics used commonly but not classically associated with CDAD frequently precipitate this infection. Finally, the use of prophylactic antibiotics is not without risk, as demonstrated by the significant percentage of CDAD occurring after routine administration of these agents.
艰难梭菌相关性腹泻（CDAD）在外科患者中仍然是一个严重问题。为解决这一问题，我们对1996年12月至1998年3月期间弗吉尼亚大学医院外科住院患者中所有接受治疗的CDAD病例进行了前瞻性研究。CDAD占1000例总感染病例的3.2%（32例）。与随机选择的患有其他医院感染的对照组相比，CDAD患者从入院到感染诊断的时间更长（19±4天对9±1天；P = 0.01），女性更常见（66%对37%；P = 0.009），总体粗死亡率更高（31%对11%；P = 0.01），尽管没有直接归因于CDAD的死亡病例。环丙沙星（19%）和头孢西丁（16%）是CDAD诊断前最常用的单一抗生素。从抗生素治疗结束到CDAD诊断的平均时间为7±2天（范围为0 - 58天）。16%（32例中的5例）仅在围手术期预防性使用抗生素后发生了CDAD。与CDAD相关的高粗死亡率表明，这可能是感染外科患者预后不良的一个重要预测指标。通常使用但并非典型地与CDAD相关的抗生素经常引发这种感染。最后，预防性使用抗生素并非没有风险，常规使用这些药物后发生显著比例的CDAD就证明了这一点。
