Mizui T, Teramachi H, Tachi T, Tamura K, Shiga H, Komada N, Umeda M, Koda A, Aoyama S, Goto C, Tsuchiya T
Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan.
Pharmazie. 2013 Aug;68(8):706-10.
Measures for prevention of Clostridium difficile-associated diarrhea, a common nosocomial infection, in hospital settings are urgently needed. This study was conducted to identify the risk factors contributing to C. difficile-associated diarrhea and to evaluate the clinical benefit of probiotics in its prevention. The study included 2716 patients at least 20 years old who received an injected antibiotic at any time between February 2010 and February 2011; a total of 2687 patients (98.9%) were assigned to the non-C. difficile-associated diarrhea group, and 29 patients (1.1%) were assigned to the C. difficile-associated diarrhea group. Univariate analysis revealed a significant difference between the two groups for the following factors: antibiotic therapy for > or = 8 days; enteral nutrition; intravenous hyperalimentation; fasting; proton pump inhibitor use; H2 blocker use; and serum albumin < or = 2.9g/dL (p<0.05). Multivariate logistic regression analysis revealed a significant difference between the two groups for several factors. Antibiotic therapy for > or = 8 days, intravenous hyperalimentation, proton pump inhibitor use, and H2 blocker use were therefore shown to be risk factors for C. difficile-associated diarrhea. Prophylactic probiotic therapy was not shown to suppress the occurrence of C. difficile-associated diarrhea.
医院环境中急需预防艰难梭菌相关性腹泻（一种常见的医院感染）的措施。本研究旨在确定导致艰难梭菌相关性腹泻的危险因素，并评估益生菌在预防该病方面的临床益处。该研究纳入了2716名年龄至少20岁、在2010年2月至2011年2月期间的任何时间接受过注射用抗生素治疗的患者；共有2687名患者（98.9%）被分配到非艰难梭菌相关性腹泻组，29名患者（1.1%）被分配到艰难梭菌相关性腹泻组。单因素分析显示，两组在以下因素方面存在显著差异：抗生素治疗≥8天；肠内营养；静脉高营养；禁食；使用质子泵抑制剂；使用H2阻滞剂；血清白蛋白≤2.9g/dL（p<0.05）。多因素逻辑回归分析显示，两组在几个因素方面存在显著差异。因此，抗生素治疗≥8天、静脉高营养、使用质子泵抑制剂和使用H2阻滞剂被证明为艰难梭菌相关性腹泻的危险因素。预防性益生菌治疗未显示出可抑制艰难梭菌相关性腹泻的发生。
