Department of Gastroenterology and Hepatology, St. George's Hospital, Tooting, London, SW17 0QT, UK.
Neurocrit Care. 2010 Aug;13(1):87-92. doi: 10.1007/s12028-010-9374-x.
Clostridium difficile is an important cause of nosocomial infection on the intensive care unit. Little is known about infection rates on the neurocritical care unit (NICU). The purpose of this study was to determine the prevalence, severity, and outcome associated with Clostridium difficile-associated disease (CDAD) acquired on the NICU.
Patients on NICU with a positive stool Clostridium difficile toxin assay, from August 2004 to February 2008, were identified by the Department of Microbiology. Each patient's medical notes and charts were reviewed in turn. Patients with a positive assay within 48 h of NICU admission were excluded.
Twenty-one (0.6%) NICU patients developed CDAD. All were emergency admissions, 18 (86.0%) were neurosurgical. Subarachnoid hemorrhage was the most common diagnosis, 5 (23.8%) patients. Median age and APACHE II score on admission were 55 (IQR 40-66) and 21 (IQR 16-24), respectively. Thirteen (61.9%) patients were female. Median interval between NICU admission and diarrhea onset and CDAD diagnosis were 5 (3-8) days and 7 (4-12) days, respectively. At the time of diagnosis most, 11 (52.4%) patients, had moderate CDAD. Previously identified risk factors for ICU-acquired CDAD comprised: age > 65 (6), antibiotics (21), and medical device requirements (21). Five (23.8%) patients deteriorated clinically as a result of CDAD. The overall in-hospital mortality for those with NICU acquired CDAD was 19%.
Although CDAD is rarely acquired on the NICU, up to one quarter of affected patients may experience complications. Prospective validation of severity definitions and treatment guidelines may help to reduce the complication rates.
艰难梭菌是重症监护病房医院感染的重要原因。关于神经重症监护病房（NICU）的感染率知之甚少。本研究的目的是确定在 NICU 获得的艰难梭菌相关性疾病（CDAD）的患病率、严重程度和结果。
通过微生物学系确定 2004 年 8 月至 2008 年 2 月期间在 NICU 中粪便艰难梭菌毒素检测呈阳性的患者。依次回顾每位患者的病历和图表。排除在 NICU 入院后 48 小时内检测呈阳性的患者。
21 例（0.6%）NICU 患者发生 CDAD。均为急诊入院，18 例（86.0%）为神经外科患者。蛛网膜下腔出血是最常见的诊断，有 5 例（23.8%）患者。入院时的中位年龄和急性生理学与慢性健康状况评分系统 II（APACHE II）评分为 55（四分位距 40-66）和 21（四分位距 16-24）。13 例（61.9%）患者为女性。NICU 入院与腹泻发作和 CDAD 诊断之间的中位间隔时间分别为 5（3-8）天和 7（4-12）天。在诊断时，大多数患者（52.4%）患有中度 CDAD。先前确定的 ICU 获得性 CDAD 的危险因素包括：年龄>65 岁（6 例）、抗生素（21 例）和医疗器械需求（21 例）。5 例（23.8%）患者因 CDAD 而临床恶化。在 NICU 获得 CDAD 的患者中，总住院死亡率为 19%。
尽管 NICU 很少获得 CDAD，但多达四分之一的受影响患者可能会出现并发症。前瞻性验证严重程度定义和治疗指南可能有助于降低并发症发生率。
