Guastalegname M, Grieco S, Giuliano S, Falcone M, Caccese R, Carfagna P, D'ambrosio M, Taliani G, Venditti M
Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Infection. 2014 Jun;42(3):585-9. doi: 10.1007/s15010-014-0597-1. Epub 2014 Feb 13.
We describe, for the first time, a cluster of lethal fulminant health-care associated Clostridium difficile (CD) colitis in Italy, observed in the intensive care unit (ICU) of an Italian tertiary care hospital in Rome. For all cases the cause of ICU admission was CD-related septic shock. Three out of seven patients were residents in a long-term care facility in Rome, and the others had been transferred to the ICU from different medical wards of the same hospital. Five patients died within 96 h of ICU admission. Because of a clinical deterioration after 4 days of adequate antibiotic therapy, two patients underwent subtotal colectomy: both of them died within 30 days of surgical intervention. In four cases, ribotyping assay was performed and ribotype 027 was recognized. This high mortality rate could be attributable to three findings: the extent of disease severity induced by the strain 027, the delay in antimicrobial therapy administration, and the lack of efficacy of the standard antibiotic treatment for fulminant CD colitis compared to an earlier surgical approach. In order to contain a CD infection epidemic, control and surveillance measures should be implemented, and empirical therapy should be administered. Because of potential 027 ribotype CD spread in Italy, CDI should be regarded with a high index of suspicion in all patients presenting with shock and signs or symptoms suggesting abdominal disease, and an early surgical approach should be considered.
我们首次描述了在意大利罗马一家三级护理医院的重症监护病房（ICU）中观察到的一组与医疗保健相关的致命性暴发性艰难梭菌（CD）结肠炎。所有病例入住ICU的原因均为与CD相关的感染性休克。7名患者中有3名是罗马一家长期护理机构的居民，其他患者则是从同一家医院的不同内科病房转入ICU的。5名患者在入住ICU的96小时内死亡。由于在进行了4天充分的抗生素治疗后临床病情恶化，2名患者接受了结肠次全切除术：两人均在手术干预后的30天内死亡。在4例病例中进行了核糖分型检测，识别出核糖型027。这种高死亡率可能归因于三个发现：027菌株引起的疾病严重程度、抗菌治疗给药的延迟，以及与早期手术方法相比，标准抗生素治疗对暴发性CD结肠炎缺乏疗效。为了控制CD感染的流行，应实施控制和监测措施，并给予经验性治疗。由于027核糖型CD在意大利有潜在传播，对于所有出现休克以及提示腹部疾病的体征或症状的患者，应高度怀疑CDI，并应考虑早期手术方法。
