Department of Medicine, Division of Gastroenterology, Inflammatory Bowel Disease Center, Mount Sinai School of Medicine, New York, NY, USA.
Dig Dis Sci. 2010 Feb;55(2):415-20. doi: 10.1007/s10620-009-0749-9. Epub 2009 Mar 3.
The incidence of Clostridium difficile infection is increasing in the United States. The aim of our investigation is to compare short-term and long-term outcomes of patients admitted with an ulcerative colitis (UC) flare and co-existent C. difficile infection to those of non-infected patients.
A historical cohort study was undertaken examining admissions at Mount Sinai Hospital between June 2004 and June 2005 using ICD-9 criteria for UC. Charts were abstracted for those patients for whom C. difficile testing was performed.
Of 288 admissions, 99 charts met the inclusion criteria. Fifty-two patients were C. difficile-negative and 47 were positive. Demographic data and laboratory values upon admission did not differ between the two groups. Patients who were C. difficile-positive had significantly more UC-related hospitalizations and emergency room visits in the year following initial admission (58 visits vs. 27, P = 0.001 and eight visits vs. 1 visit (P = 0.012), respectively). One year following the index admission, C. difficile patients had significantly higher rates of colectomy compared to C. difficile-negative patients (44.6% vs. 25%, P = 0.04). Length of hospitalization (11.7 vs. 11 days), use of cyclosporine therapy during index admission (48% vs. 47% of patients), and percentage requiring colectomy at initial admission (23.4% vs. 13.5%) did not reach statistical significance.
Our data suggest that patients presenting with a UC flare who are infected with C. difficile have worse long-term clinical outcomes than those that are C. difficile-negative. C. difficile testing should be performed for all patients presenting with UC flare. Further studies are warranted to elucidate how infection can alter the natural history of UC.
在美国，艰难梭菌感染的发病率正在上升。我们的研究旨在比较患有溃疡性结肠炎（UC）发作和并存艰难梭菌感染的患者与未感染患者的短期和长期结局。
采用回顾性队列研究，使用 ICD-9 标准对 2004 年 6 月至 2005 年 6 月期间在西奈山医院的住院患者进行检查。对接受艰难梭菌检测的患者的病历进行了摘录。
在 288 例住院患者中，99 份病历符合纳入标准。52 例患者艰难梭菌检测结果为阴性，47 例为阳性。两组患者入院时的人口统计学数据和实验室值无差异。艰难梭菌阳性患者在初次入院后 1 年内 UC 相关住院和急诊就诊次数明显更多（58 次就诊 vs. 27 次，P = 0.001；8 次就诊 vs. 1 次就诊，P = 0.012）。在初次入院后 1 年，艰难梭菌患者接受结肠切除术的比例明显高于艰难梭菌阴性患者（44.6% vs. 25%，P = 0.04）。住院时间（11.7 天 vs. 11 天）、初次入院时使用环孢素治疗的比例（48% vs. 47%的患者）和初次入院时需要结肠切除术的比例（23.4% vs. 13.5%）均无统计学意义。
我们的数据表明，患有 UC 发作且感染艰难梭菌的患者比艰难梭菌阴性患者的长期临床结局更差。所有患有 UC 发作的患者都应进行艰难梭菌检测。需要进一步研究阐明感染如何改变 UC 的自然病程。
