Ingle Meghraj, Deshmukh Abhijit, Desai Devendra, Abraham Philip, Joshi Anand, Gupta Tarun, Rodrigues Camilla
Division of Gastroenterology, P D Hinduja National Hospital and Medical Research Center, Veer Savarkar Marg, Mahim West, Mumbai 400 016, India.
Indian J Gastroenterol. 2013 May;32(3):179-83. doi: 10.1007/s12664-013-0303-8. Epub 2013 Mar 24.
Clostridium difficile-associated diarrhea (CDAD) is an increasing problem. Recent reports suggest presence of community acquired CDAD (CA CDAD). Studies in India have shown varied results.
The following are the aims of this study: (a) the prevalence of CDAD and CA CDAD in patients with acute diarrhea; (b) the incremental yield of second stool sample for the diagnosis of C. difficile infection (CDI); and (c) the risk factors for CDI.
Patients with acute diarrhea (<4 weeks) between April 2009 and December 2010 had two stool sample tested for C. difficile toxin (CDT) by enzyme-linked immunofluorescent assay. Demographic, clinical data, risk factors, clinical course, complications, treatment, and response were noted.
Of 150 patients (mean age, 47.3 years; 76 males), 12 (8 %) had their first stool sample positive for CDT. Two patients (1.3 %) had community acquired CDI. The study group was compared with 138 patients ("control group", stool samples negative for CDT). Compared to the controls, the study group were more likely to have had intensive care unit (ICU) stay (p = 0.018) and tube feeding (p = 0.035). Eleven patients were treated with metronidazole. One patient did not respond to metronidazole and was treated with vancomycin. No patient developed complications of CDAD.
The prevalence of CDAD in our population was 8 % and of CA CDAD was 1.3 %. There was no advantage of testing two samples. ICU stay and tube feeding were major risk factors for the CDAD. Metronidazole was an effective first-line therapy.
艰难梭菌相关性腹泻（CDAD）是一个日益严重的问题。最近的报告表明存在社区获得性CDAD（CA CDAD）。印度的研究结果各不相同。
本研究的目的如下：（a）急性腹泻患者中CDAD和CA CDAD的患病率；（b）第二次粪便样本对艰难梭菌感染（CDI）诊断的增量收益；（c）CDI的危险因素。
2009年4月至2010年12月期间患有急性腹泻（<4周）的患者的两份粪便样本通过酶联免疫荧光法检测艰难梭菌毒素（CDT）。记录人口统计学、临床数据、危险因素、临床过程、并发症、治疗及反应。
150例患者（平均年龄47.3岁；76例男性）中，12例（8%）首次粪便样本CDT呈阳性。2例患者（1.3%）患有社区获得性CDI。将研究组与138例患者（“对照组”，粪便样本CDT阴性）进行比较。与对照组相比，研究组更有可能入住重症监护病房（ICU）（p = 0.018）和接受管饲（p = 0.035）。11例患者接受甲硝唑治疗。1例患者对甲硝唑无反应，接受万古霉素治疗。无患者发生CDAD并发症。
我们人群中CDAD的患病率为8%，CA CDAD的患病率为1.3%。检测两份样本并无优势。入住ICU和管饲是CDAD的主要危险因素。甲硝唑是一种有效的一线治疗药物。
