透析患者相关的艰难梭菌相关性腹泻。

Clostridium difficile-associated diarrhea in dialysis patients.

机构信息

Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea.

出版信息

Kidney Res Clin Pract. 2013 Mar;32(1):27-31. doi: 10.1016/j.krcp.2012.12.002. Epub 2012 Dec 31.

DOI:10.1016/j.krcp.2012.12.002

PMID:26889434

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4716098/

Abstract

BACKGROUND

Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD).

METHODS

During the 4-year study period (2004-2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were considered as controls (n=403). We assessed the association between renal function and the prevalence and clinical outcomes of CDAD.

RESULTS

There was a significant difference in the prevalence rate of chronic kidney disease (CKD) between CDAD and non-CDAD patients (P<0.001). Sixteen patients (18.8%) of the CDAD group were treated with dialysis, whereas 21 patients (5.2%) of the non-CDAD group were treated with dialysis. There was a significant association between renal function and CDAD in patients on dialysis [odds ratio (OR)=4.44, 95% confidence interval (CI) 2.19-8.99, P<0.001], but not in patients with CKD stage 3-5 (OR=1.10, 95% CI 0.63-1.92, P=0.73). In multivariate analysis, CKD stage 5D was an independent risk factor for the development of CDAD (OR=13.36, 95% CI 2.94-60.67, P=0.001).

CONCLUSION

Our data indicate that dialysis patients might be at a greater risk of developing CDAD, which suggests that particular attention should be provided to CDAD when antibiotic treatment is administered to dialysis patients.

摘要

背景

透析患者的宿主防御机制受损，经常需要使用抗生素治疗各种感染并发症。在这项研究中，我们调查了透析患者是否有更高的风险发生艰难梭菌相关性腹泻（CDAD）。

方法

在 4 年的研究期间（2004-2008 年），通过回顾艰难梭状芽胞杆菌毒素检测或组织学记录，共确定了 85 例 CDAD 患者。将没有 CDAD 的医院获得性腹泻患者作为对照（n=403）。我们评估了肾功能与 CDAD 的患病率和临床结局之间的关系。

结果

CDAD 组和非 CDAD 组的慢性肾脏病（CKD）患病率存在显著差异（P<0.001）。CDAD 组中有 16 例（18.8%）患者接受透析治疗，而非 CDAD 组中有 21 例（5.2%）患者接受透析治疗。在接受透析治疗的患者中，肾功能与 CDAD 之间存在显著关联[比值比（OR）=4.44，95%置信区间（CI）2.19-8.99，P<0.001]，但在 CKD 3-5 期患者中无显著关联（OR=1.10，95% CI 0.63-1.92，P=0.73）。多变量分析显示，CKD 5D 期是 CDAD 发生的独立危险因素（OR=13.36，95% CI 2.94-60.67，P=0.001）。