Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic, Cleveland, OH 44195, USA.
J Crohns Colitis. 2011 Feb;5(1):34-40. doi: 10.1016/j.crohns.2010.09.007. Epub 2010 Oct 30.
Clostridium difficile infection (CDI) is becoming prevalent in general population as well as in patients with inflammatory bowel disease (IBD).
The aim of the study was to identify risk factors for CDI in patients with ulcerative colitis (UC) and to assess outcome of UC in patients following CDI.
UC inpatients or outpatients who had positive results for C. difficile toxins A and B between 2000 and 2006 were identified (N=39) and matched for age and gender to UC patients who were negative C. difficile toxins and had never been diagnosed with CDI (N=39). Records were reviewed for adverse clinical outcome, defined as colectomy within 3 months of C. difficile testing. Conditional logistic regression was used to analyze multivariable association to identify risk factors for CDI and for adverse clinical outcome.
A total of 78 subjects were analyzed, 60% were males. Median age was 39. Among 39 patients with CDI, 20 (47.2%) were diagnosed as outpatients, 50% failed treatment with the first antibiotic monotherapy, and 21.2% had recurrent infection. Antibiotic exposure within 30 days prior to C. difficile testing was found to be associated with an increased risk for CDI with an odds ratio of 12.0 (95% CI 1.2, 124.2) Subsequent colectomy within 3 months after CDI diagnosis, was not associated with CDI in both univariable and multivariable analyses. After adjusting for CDI, lack of 5-aminosalicylic acid (ASA) in the treatment regimen was significantly associated with colectomy with an odds ratio of 3.3 (95% CI: 1.2, 9.4). There was no UC- or CDI-associated mortality in this case series.
Recent antibiotic exposure was a risk factor for CDI in UC patients. Interestingly, CDI does not seem to adversely affect short-term adverse clinical outcome (colectomy).
艰难梭菌感染（CDI）在普通人群和炎症性肠病（IBD）患者中越来越普遍。
本研究旨在确定溃疡性结肠炎（UC）患者中 CDI 的危险因素，并评估 CDI 后 UC 患者的结局。
2000 年至 2006 年间，我们确定了艰难梭菌毒素 A 和 B 检测结果阳性的住院或门诊 UC 患者（N=39），并按年龄和性别与艰难梭菌毒素阴性且从未被诊断为 CDI 的 UC 患者（N=39）相匹配。我们回顾了记录，以确定不良临床结局，定义为艰难梭菌检测后 3 个月内进行结肠切除术。我们使用条件逻辑回归分析多变量关联，以确定 CDI 和不良临床结局的危险因素。
共分析了 78 例患者，其中 60%为男性，中位年龄为 39 岁。在 39 例 CDI 患者中，20 例（47.2%）为门诊患者，50%的患者对首次抗生素单药治疗失败，21.2%的患者出现复发感染。在艰难梭菌检测前 30 天内使用抗生素与 CDI 风险增加相关，优势比为 12.0（95%CI 1.2,124.2）。在单变量和多变量分析中，CDI 诊断后 3 个月内进行结肠切除术均与 CDI 无关。在调整了 CDI 后，治疗方案中缺乏 5-氨基水杨酸（ASA）与结肠切除术显著相关，优势比为 3.3（95%CI：1.2,9.4）。在本病例系列中，没有与 UC 或 CDI 相关的死亡。
近期抗生素暴露是 UC 患者 CDI 的危险因素。有趣的是，CDI 似乎不会对短期不良临床结局（结肠切除术）产生不利影响。
