Keven K, Basu A, Re L, Tan H, Marcos A, Fung J J, Starzl T E, Simmons R L, Shapiro R
Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, MUH 7 South, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
Transpl Infect Dis. 2004 Mar;6(1):10-4. doi: 10.1111/j.1399-3062.2004.00040.x.
Limited data exist about Clostridium difficile colitis (CDC) in solid organ transplant patients. Between 1/1/99 and 12/31/02, 600 kidney and 102 pancreas-kidney allograft recipients were transplanted. Thirty-nine (5.5%) of these patients had CDC on the basis of clinical and laboratory findings. Of these 39 patients, 35 have information available for review. CDC developed at a median of 30 days after transplantation, and the patients undergoing pancreas-kidney transplantation had a slightly higher incidence of CDC than recipients of kidney alone (7.8% vs. 4.5%, P>0.05). All but one patient presented with diarrhea. Twenty-four patients (64.9%) were diagnosed in the hospital, and CDC occurred during first hospitalization in 14 patients (40%). Treatment was with oral metronidazole (M) in 33 patients (94%) and M+oral vancomycin (M+V) in 2 patients. Eight patients had recurrent CDC, which occurred at a median of 30 days (range 15-314) after the first episode. Two patients (5.7%) developed fulminant CDC, presented with toxic megacolon, and underwent colectomy. One of them died; the other patient survived after colectomy. CDC should be considered as a diagnosis in transplant patients with history of diarrhea after antibiotic use, and should be treated aggressively before the infection becomes complicated.
关于实体器官移植患者艰难梭菌结肠炎（CDC）的资料有限。在1999年1月1日至2002年12月31日期间，600例肾移植和102例胰肾联合移植受者接受了移植手术。根据临床和实验室检查结果，其中39例（5.5%）患者患有CDC。在这39例患者中，35例有可供查阅的资料。CDC发病的中位时间为移植后30天，胰肾联合移植患者的CDC发病率略高于单纯肾移植受者（7.8%对4.5%，P>0.05）。除1例患者外，所有患者均出现腹泻。24例患者（64.9%）在医院确诊，14例患者（40%）在首次住院期间发生CDC。33例患者（94%）接受口服甲硝唑（M）治疗，2例患者接受M+口服万古霉素（M+V）治疗。8例患者出现复发性CDC，复发的中位时间为首次发作后30天（范围15 - 314天）。2例患者（5.7%）发生暴发性CDC，出现中毒性巨结肠，并接受了结肠切除术。其中1例死亡；另1例患者结肠切除术后存活。对于有抗生素使用后腹泻病史的移植患者，应考虑CDC的诊断，并应在感染复杂化之前积极治疗。
