Jackson Melissa, Olefson Sidney, Machan Jason T, Kelly Colleen R
*Department of Internal Medicine, Brown Alpert Medical School †Department of Orthopedics and Surgery, The Warren Alpert Medical School, Brown University §Lifespan Biostatistics Core, Lifespan Hospital System ∥Division of Gastroenterology, Women's Medicine Collaborative, Alpert Medical School of Brown University, Providence ‡Department of Psychology, University of Rhode Island, Kingston, RI.
J Clin Gastroenterol. 2016 Oct;50(9):742-6. doi: 10.1097/MCG.0000000000000447.
We evaluated a cohort of patients referred to our center for presumed recurrent Clostridium difficile infection (CDI) to determine final diagnoses and outcomes.
As rates of CDI have increased, more patients are diagnosed with recurrent CDI and other sequelae of the infection. Distinguishing symptomatic patients with CDI from those who are colonized with an alternative etiology of diarrheal symptoms may be challenging.
We performed a retrospective review of 117 patients referred to our center for recurrent CDI between January 2013 and June 2014. Data collected included demographics, the referring provider, previous anti-CDI treatment, and significant medical conditions. In addition, we gathered data on atypical features of CDI and investigations obtained to investigate the etiology of symptoms. Outcomes included rates of alternative diagnoses and the accuracy of CDI diagnosis by the referral source.
The mean age was 61 years, and 70% were female. About 29 patients (25%) were determined to have a non-CDI diagnosis. Most common alternative diagnoses included irritable bowel syndrome (18 patients: 62%) and inflammatory bowel disease (3 patients:10%). The age was inversely correlated with the rate of non-CDI diagnosis (P=0.016). Of the remaining 88 (75%) patients with a confirmed diagnosis of CDI, 25 (28%) received medical therapy alone and 63 (72%) underwent fecal microbiota transplantation.
Among patients referred to our center for recurrent CDI, a considerable percentage did not have CDI, but rather an alternative diagnosis, most commonly irritable bowel syndrome. The rate of alternative diagnosis correlated inversely with age. Providers should consider other etiologies of diarrhea in patients presenting with features atypical of recurrent CDI.
我们评估了一组因疑似复发性艰难梭菌感染（CDI）而转诊至本中心的患者，以确定最终诊断和结局。
随着CDI发病率的上升，越来越多的患者被诊断为复发性CDI及该感染的其他后遗症。将有症状的CDI患者与因腹泻症状的其他病因定植的患者区分开来可能具有挑战性。
我们对2013年1月至2014年6月间因复发性CDI转诊至本中心的117例患者进行了回顾性研究。收集的数据包括人口统计学信息、转诊医生、既往抗CDI治疗情况以及重大疾病情况。此外，我们收集了CDI非典型特征的数据以及为调查症状病因所进行的检查。结局包括替代诊断的发生率以及转诊来源对CDI诊断的准确性。
平均年龄为61岁，70%为女性。约29例患者（25%）被确定为非CDI诊断。最常见的替代诊断包括肠易激综合征（18例患者：62%）和炎症性肠病（3例患者：10%）。年龄与非CDI诊断率呈负相关（P=0.016）。其余88例（75%）确诊为CDI的患者中，25例（28%）仅接受药物治疗，63例（72%）接受了粪便微生物群移植。
在因复发性CDI转诊至本中心的患者中，相当一部分患者并非CDI，而是有其他诊断，最常见的是肠易激综合征。替代诊断率与年龄呈负相关。对于表现出复发性CDI非典型特征的患者，医生应考虑腹泻的其他病因。
