Pant Chaitanya, Sferra Thomas J, Ondrade Christina, Bass Pat F, Deshpande Abhishek, Burton Cary V
Louisiana State University Health Sciences Center, Shreveport, USA.
J La State Med Soc. 2011 Mar-Apr;163(2):91-4.
Clostridium difficile infection (CDI) has emerged as the leading cause of nosocomial diarrhea in the developed world. The prompt recognition of severe CDI is essential in providing early aggressive therapy. Though previous studies have identified leukocytosis, azotemia, and hypoalbuminemia as markers to differentiate severe from non-severe CDI in the general patient population, there is little data in immunosuppressed patients. We conducted a retrospective chart review of immunosuppressed patients with CDI to identify serum markers associated with severe CDI. Twenty-nine immunosuppressed patients with CDI (nine with severe disease) were identified. Those with severe disease were older and had evidence of renal dysfunction. The white blood cell count, platelet, and albumin levels were the same in the severe and non-severe immunosuppressed CDI patients. Therefore, recognized serum markers of severe CDI are not universally useful in immunosuppressed patients. Moreover, the clinician must be aware that immunosuppressed patients can develop severe CDI while remaining leukopenic.
艰难梭菌感染（CDI）已成为发达国家医院获得性腹泻的主要原因。迅速识别严重CDI对于提供早期积极治疗至关重要。尽管先前的研究已将白细胞增多、氮质血症和低白蛋白血症确定为一般患者群体中区分严重与非严重CDI的标志物，但免疫抑制患者的数据很少。我们对免疫抑制的CDI患者进行了回顾性病历审查，以确定与严重CDI相关的血清标志物。确定了二十九名免疫抑制的CDI患者（九名患有严重疾病）。患有严重疾病的患者年龄较大且有肾功能不全的证据。严重和非严重免疫抑制的CDI患者的白细胞计数、血小板和白蛋白水平相同。因此，公认的严重CDI血清标志物在免疫抑制患者中并非普遍有用。此外，临床医生必须意识到，免疫抑制患者可能在白细胞减少的情况下发生严重CDI。
