Peled Nir, Pitlik Silvio, Samra Zmira, Kazakov Arkadi, Bloch Yoram, Bishara Jihad
Institute of Pulmonology, Rabin Medical Center, Beilinson Hospital, Israel.
Infect Control Hosp Epidemiol. 2007 Apr;28(4):377-81. doi: 10.1086/513723. Epub 2007 Mar 9.
Clostridium difficile infection is implicated in 20%-30% of cases of antibiotic-associated diarrhea. Studying hospitalized patients who received antibiotic therapy and developed diarrhea, our objective was to compare the clinical characteristics of patients who developed C. difficile-associated diarrhea (CDAD) with those of patients with a negative result of a stool assay for C. difficile toxin.
A prospective study was done with a cohort of 217 hospitalized patients who had received antibiotics and developed diarrhea. Patients with CDAD were defined as patients who had diarrhea and a positive result for C. difficile toxin A/B by an enzyme immunoassay of stool. The variables that yielded a significant difference on univariate analysis between patients with a positive assay result and patients with a negative assay result were entered into a logistic regression model for prediction of C. difficile toxin.Setting. A 900-bed tertiary care medical center.
Of 217 patients, 52 (24%) had a positive result of assay for C. difficile toxin A/B in their stool. The logistic regression model included impaired functional capacity, watery diarrhea, use of a proton pump inhibitor, use of a histamine receptor blocker, leukocytosis, and hypoalbuminemia. The area under the receiver operating characteristic curve for the model as a predictor of a positive result for the stool toxin assay was 0.896 (95% confidence interval, 0.661-1.000; P<.001), with 95% specificity and 68% sensitivity.
Our results may help clinicians to predict the risk of CDAD in hospitalized patients with antibiotic-associated diarrhea, to guide careful, specific empirical therapy, and to direct early attention to infection control issues.
艰难梭菌感染与20%-30%的抗生素相关性腹泻病例有关。通过研究接受抗生素治疗并出现腹泻的住院患者，我们的目的是比较发生艰难梭菌相关性腹泻（CDAD）的患者与艰难梭菌毒素粪便检测结果为阴性的患者的临床特征。
对217例接受抗生素治疗并出现腹泻的住院患者进行了一项前瞻性研究。CDAD患者定义为腹泻且粪便酶免疫测定艰难梭菌毒素A/B呈阳性的患者。将在单因素分析中检测结果阳性患者与检测结果阴性患者之间产生显著差异的变量纳入逻辑回归模型以预测艰难梭菌毒素。研究地点：一家拥有900张床位的三级医疗中心。
217例患者中，52例（24%）粪便中艰难梭菌毒素A/B检测结果呈阳性。逻辑回归模型包括功能能力受损、水样腹泻、使用质子泵抑制剂、使用组胺受体阻滞剂、白细胞增多和低白蛋白血症。该模型作为粪便毒素检测阳性结果预测指标的受试者工作特征曲线下面积为0.896（95%置信区间，0.661-1.000；P<.001），特异性为95%，敏感性为68%。
我们的结果可能有助于临床医生预测抗生素相关性腹泻住院患者发生CDAD的风险，指导谨慎、特定的经验性治疗，并引导早期关注感染控制问题。
