Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA.
J Gastrointest Surg. 2012 Dec;16(12):2267-73. doi: 10.1007/s11605-012-2037-9. Epub 2012 Sep 25.
Recurrent Clostridium difficile colitis (RCDC) is common, but data regarding recurrence rates and predisposing factors are sparse.
A retrospective case-control study was performed, identifying all inpatients and outpatients ≥18 years of age with C. difficile colitis (CDC) confirmed by a positive stool sample collected at our institution from January 2008 to August 2011. Factors associated with RCDC, the number of RCDC episodes, and the need for admission for RCDC were sought.
A total of 739 patients (male, 47 %) were studied, of whom 527 (71 %) received inpatient treatment for their index episode of CDC. There was no difference (p = 0.53) between RCDC rates for inpatients (17.6 %) and outpatients (19.8 %). While severity score and albumin were associated with RCDC in our population, use of proton pump inhibitors (PPIs) correlated with decreased RCDC (p = 0.006) and decreased need for admission (p = 0.005). The addition of vancomycin to metronidazole therapy did not lower RCDC rates (p = 0.52) or decrease the need for admission (p = 0.78).
Hypoalbuminemia strongly correlated with higher recurrence rates, while PPI therapy actually reduced RCDC, representing previously underappreciated potential therapeutic targets for lowering CDC recurrence. The addition of vancomycin to metronidazole did not improve RCDC rates.
复发性艰难梭菌结肠炎（RCDC）很常见，但关于复发率和易患因素的数据却很少。
我们进行了一项回顾性病例对照研究，确定了 2008 年 1 月至 2011 年 8 月在我院采集的阳性粪便样本确诊为艰难梭菌结肠炎（CDC）的所有≥18 岁的住院和门诊患者。寻找与 RCDC 相关的因素、RCDC 发作次数以及 RCDC 住院的必要性。
共研究了 739 例患者（男性占 47%），其中 527 例（71%）因 CDC 指数发作接受住院治疗。住院患者（17.6%）和门诊患者（19.8%）的 RCDC 发生率没有差异（p=0.53）。虽然严重程度评分和白蛋白与本人群中的 RCDC 相关，但质子泵抑制剂（PPIs）的使用与 RCDC 减少相关（p=0.006），并降低了住院的必要性（p=0.005）。万古霉素联合甲硝唑治疗并未降低 RCDC 发生率（p=0.52）或减少住院的必要性（p=0.78）。
低白蛋白血症与较高的复发率密切相关，而 PPI 治疗实际上降低了 RCDC，这代表了以前被低估的降低 CDC 复发的潜在治疗靶点。万古霉素联合甲硝唑治疗并未改善 RCDC 发生率。
