Zemanová E, Urban O, Chalupa J, Mrózek V, Taubová V
Interní oddĕlení Nemocnice, Frýdek-Místek.
Vnitr Lek. 2003 Aug;49(8):645-9.
At a regional hospital serving 150,000 inhabitants, the authors were tracking the occurrence of antibiotic-associated diarrhea caused by a nosocomial infection of the Clostridium difficile, especially its most serious form--pseudomembranous colitis. Six cases of the disease were found in a retrospective study in 2001, another 20 cases were diagnosed while actively searching for the disease from January till September of 2002. The patients suffered from many complications, were of an average age of 69.24 years, their hospitalization averaged 34 days and 15 (52%) of them underwent surgery during their hospitalization. It could be demonstrably proved that 25 cases of nosocomial infection occurred during hospitalization and 3 patients were admitted to hospital with the disease. However, 2 of them had been released from hospital less than 20 days before being admitted again. Twenty-five patients (96%) had been treated with antibiotics, often in combined therapy. Most often this involved penicillin with betalactamas activity (50%), clindamycin (42%) and cefalosporins (42%). We used methods for detecting enterotoxin A in the stool, rectoscopy and anaerobic cultivation of the stool in the diagnostic process. Rectoscopy discovered pseudomembranous colitis in 14 of 17 patients examined this way. The sensitivity for proving enterotoxin A in the stool using EIA, for patients with proven pseudomembranous colitis via rectoscopy, was 75%. Anaerobic cultivation of the stool was done in 12 patients and all the results were negative. The mortality rate of 38% for our group of patients testifies to the seriousness of this disease, which we consider to be the results of antibiotic therapy. In conclusion, nosocomial infection caused by Clostridium difficile is quite often a nosocomial disease, a prognosis that especially worsens for seriously ill patients.
在一家为15万居民服务的地区医院，作者们追踪由艰难梭菌医院感染引起的抗生素相关性腹泻的发生情况，尤其是其最严重的形式——伪膜性结肠炎。在2001年的一项回顾性研究中发现了6例该疾病，在2002年1月至9月积极筛查该疾病时又诊断出20例。患者出现了许多并发症，平均年龄为69.24岁，平均住院时间为34天，其中15例（52%）在住院期间接受了手术。可以明确证明，25例医院感染发生在住院期间，3例患者入院时即患有该疾病。然而，其中2例在再次入院前不到20天已出院。25例患者（96%）接受过抗生素治疗，且常为联合治疗。最常用的是具有β-内酰胺酶活性的青霉素（50%）、克林霉素（42%）和头孢菌素（42%）。在诊断过程中，我们采用了检测粪便中肠毒素A、直肠镜检查和粪便厌氧培养的方法。通过这种方式对17例患者进行直肠镜检查，发现14例患有伪膜性结肠炎。对于经直肠镜检查确诊为伪膜性结肠炎的患者，使用酶免疫分析检测粪便中肠毒素A的敏感度为75%。对12例患者进行了粪便厌氧培养，所有结果均为阴性。我们这组患者38%的死亡率证明了该疾病的严重性，我们认为这是抗生素治疗的结果。总之，艰难梭菌引起的医院感染常常是一种医院内疾病，对于重症患者来说预后尤其差。
