Chang Heidi T, Krezolek Dorota, Johnson Stuart, Parada Jorge P, Evans Charlesnika T, Gerding Dale N
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA.
Infect Control Hosp Epidemiol. 2007 Aug;28(8):926-31. doi: 10.1086/519178. Epub 2007 Jun 14.
To identify patients with a diagnosis of Clostridium difficile-associated disease (CDAD) in the ambulatory care setting and determine the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials.
Single-center, retrospective study.
Medical records were reviewed for outpatients and hospitalized patients with a stool assay positive for C. difficile toxin A from January 1998 through March 2005. Patients with recurrent CDAD or residing in an extended-care facility were excluded. CDAD in patients who had been hospitalized in the 100 days prior to diagnosis was considered potentially hospital-associated.
Of the 84 patients who met the inclusion criteria, 75 (89%) received a diagnosis 1-60 days after hospital discharge (median, 12 days), and 71 (85%) received a diagnosis within 30 days after discharge. Of the 69 patients whose records contained information regarding time of symptom onset, 62 (90%) developed diarrhea within 30 days of a previous hospital discharge, including 7 patients with symptom onset prior to discharge and 9 with onset on the day of discharge. The median time from symptom onset to diagnosis was 6 days. Of 84 patients, 77 (92%) had received antimicrobials during a prior hospitalization, but 55 (65%) received antimicrobials both as inpatients and as outpatients.
If all cases of CDAD diagnosed within 100 days of hospital discharge were assumed to be hospital-associated, 71 (85%) of 84 patients with CDAD were identified within 30 days, and 75 (89%) of 84 were identified by day 60. Continued outpatient antimicrobial exposure confounds determination of whether late-onset cases are community- or hospital-associated.
在门诊护理环境中识别诊断为艰难梭菌相关性疾病（CDAD）的患者，并确定症状发作和诊断与既往住院及接触抗菌药物之间的关系。
单中心回顾性研究。
回顾1998年1月至2005年3月期间粪便检测艰难梭菌毒素A呈阳性的门诊患者和住院患者的病历。排除复发性CDAD患者或居住在长期护理机构的患者。诊断前100天内曾住院的患者的CDAD被视为可能与医院相关。
在符合纳入标准的84例患者中，75例（89%）在出院后1至60天内得到诊断（中位数为12天），71例（85%）在出院后30天内得到诊断。在69例病历包含症状发作时间信息的患者中，62例（90%）在先前出院后30天内出现腹泻，其中7例症状在出院前发作，9例在出院当天发作。从症状发作到诊断的中位时间为6天。84例患者中，77例（92%）在先前住院期间接受过抗菌药物治疗，但55例（65%）住院和门诊时均接受过抗菌药物治疗。
如果将出院后100天内诊断的所有CDAD病例都假定为与医院相关，那么84例CDAD患者中有71例（85%）在30天内被识别出来，84例中有75例（89%）在60天内被识别出来。持续的门诊抗菌药物接触混淆了迟发性病例是社区相关还是医院相关的判定。
