Haider Naqvi Syed Ali, Chaudhry Faisal Fiaz
Department of Medicine and Cardiology, Sindh Government Hospital, Karachi, Pakistan.
J Coll Physicians Surg Pak. 2012 Oct;22(10):640-3. doi: 10.2012/JCPSP.640643.
To study the frequency of Clostridium difficile in postantibiotic diarrhoea in patients admitted to the medical ward of a secondary care hospital.
Observational study.
Sindh Government Hospital, Liaquatabad, Karachi, from June 2002 to May 2009.
Adults of either gender who received antibiotics after admission and subsequently had watery stools at least 2 days after admission were selected. The exclusion criteria were past history of inflammatory bowel disease or any type of malabsorption state and those who did not show WBCs in stools. All variables of these patients along with clinical findings, type of antibiotic received, and number of stool motions per day were recorded. Three samples of the stools were sent for detailed reports to analyze the number of leukocytes per high field and culture, on cycloserine - cefoxitin - fructose agar (CCFA). All findings were entered into and analyzed by SPSS 16 for statistical analysis.
Out of the 473 patients who received antibiotics for any reasons, 191 (40.38%) developed diarrhoea. The mean age was 45.6 + 17.73 years and male to female ratio was 1.85:1. The average number of stools passed per day was 4.84 ± 1.24 and all patients showed leukocytes in stool samples with a mean count of 6.67 ± 0.89/HPF. The stool culture on CCFA was positive for 57 patients (29.18%), while 134 patients (70.15%) were stool culture negative as well as negative for evidence of any parasites; these samples were labelled benign antibiotic associated diarrhoea (BAAD). Ampicillin and amoxicillin with clavulanate were the most implicated antibiotics in this study.
Clostridium difficile is the main putative agent in postantibiotic diarrhoea. In settings with limited resources, use of specific culture media such as CCFA proves to be highly cost effective, and sensitive for this diagnosis. Macrolides and quinolones are the safest agents to prescribe in this context.
研究一家二级护理医院内科病房抗生素相关性腹泻患者中艰难梭菌的感染率。
观察性研究。
2002年6月至2009年5月，卡拉奇利亚夸塔巴德的信德省政府医院。
选取入院后接受抗生素治疗且入院至少2天后出现水样便的成年患者，男女不限。排除标准为既往有炎症性肠病病史或任何类型的吸收不良状态，以及粪便中未发现白细胞的患者。记录这些患者的所有变量，以及临床表现、所用抗生素类型和每日排便次数。采集三份粪便样本，送去做详细报告，以分析每高倍视野白细胞数量并在环丝氨酸-头孢西丁-果糖琼脂（CCFA）上进行培养。所有结果录入SPSS 16进行统计分析。
在473例因任何原因接受抗生素治疗的患者中，191例（40.38%）出现腹泻。平均年龄为45.6±17.73岁，男女比例为1.85:1。每日平均排便次数为4.84±1.24次，所有患者粪便样本中均发现白细胞，平均计数为6.67±0.89/HPF。CCFA粪便培养57例阳性（29.18%），134例（70.15%）粪便培养阴性且未发现任何寄生虫迹象；这些样本被标记为良性抗生素相关性腹泻（BAAD）。氨苄西林和阿莫西林克拉维酸是本研究中最常涉及的抗生素。
艰难梭菌是抗生素相关性腹泻的主要假定病原体。在资源有限的情况下，使用CCFA等特定培养基对该诊断具有很高的成本效益且敏感。在这种情况下，大环内酯类和喹诺酮类是最安全的用药选择。
