Gifford A H, Kirkland K B
Section of General Internal Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Eur J Clin Microbiol Infect Dis. 2006 Dec;25(12):751-5. doi: 10.1007/s10096-006-0220-1.
Nosocomial diarrhea caused by Clostridium difficile causes significant morbidity and mortality in an increasing proportion of hospitalized patients annually. This case-control study of patients admitted to the hematology-oncology ward of a tertiary academic medical center over a 2-year period demonstrates that patients with Clostridium difficile-associated diarrhea (CDAD) were 22 times more likely than ward-matched controls with diarrhea to have received any antibiotic either during hospitalization or in the month preceding admission (p < 0.005), and they were nearly three times as likely as controls to have received a cephalosporin during the same period (p < 0.005). Diarrhea among lung cancer patients was approximately three times more likely to be caused by this organism than to be due to other causes (p = 0.04). A trend towards CDAD patients receiving higher numbers of different antibiotics during hospitalization (3.3 vs. 2.6, 95%CI -1.42-0.02, p = 0.06) was noted. Administration of interleukin-2 either during hospitalization or in the 30 days preceding admission was seven times more likely to have occurred in CDAD cases (p = 0.04), raising the question of whether or not this agent increases risk.
艰难梭菌引起的医院获得性腹泻每年在越来越多的住院患者中导致显著的发病率和死亡率。这项对一家三级学术医疗中心血液肿瘤科病房收治的患者进行的为期两年的病例对照研究表明，与病房中患有腹泻的对照患者相比，艰难梭菌相关性腹泻（CDAD）患者在住院期间或入院前一个月内接受任何抗生素治疗的可能性要高22倍（p < 0.005），并且在同一时期接受头孢菌素治疗的可能性几乎是对照患者的三倍（p < 0.005）。肺癌患者的腹泻由这种病原体引起的可能性大约是由其他原因引起的三倍（p = 0.04）。注意到有这样一种趋势，即CDAD患者在住院期间接受不同抗生素的数量更多（3.3对2.6，95%CI -1.42 - 0.02，p = 0.06）。在住院期间或入院前30天内给予白细胞介素-2在CDAD病例中发生的可能性高7倍（p = 0.04），这就引发了这种药物是否会增加风险的问题。
