溃疡性结肠炎行结直肠切除回肠贮袋肛管吻合术后艰难梭菌感染

Clostridium difficile infection after restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis.

作者信息

Martinez Ugarte M L, Lightner A L, Colibaseanu D, Khanna S, Pardi D S, Dozois E J, Mathis K L

机构信息

Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Colorectal Dis. 2016 May;18(5):O154-7. doi: 10.1111/codi.13325.

DOI:10.1111/codi.13325

PMID:26945555

Abstract

AIM

Clostridium difficile infection (CDI) of the ileal pouch following restorative proctocolectomy (RPC) is becoming increasingly recognized. We aimed to understand better (i) the associated risk factors, (ii) treatment practices and (iii) the pouch diversion and failure rate in patients who developed CDI of the pouch after RPC for ulcerative colitis (UC).

METHOD

Patients who tested positive for C. difficile of the pouch between 2007 and 2010 were included in the analysis. Data collected included patient demographics, time from RPC to documented CDI, the treatment of CDI and rate of excision of the pouch.

RESULTS

Of 2785 patients recorded in the hospital CDI database, 15 had had an RPC with ileal pouch anal anastomosis. The median age was 44 years and the median interval from RPC to first documented episode of CDI was 3 years. Thirteen (81%) patients had had multiple episodes of pouchitis before and after CDI infection, and all were symptomatic at the time of testing for CDI. Within 30 days of the diagnosis of CDI, six (40%) patients were taking immunosuppressive medication, seven (47%) were taking a proton pump inhibitor and 12 (80%) had received antibiotics. Five patients required hospitalization for CDI and four had severe infections characterized by a serum creatinine more than 1.5 times baseline (n = 3) and a white cell count above 15 000 (n = 1). Six patients who underwent endoscopy had severe inflammation of the pouch including the presence of a pseudomembrane in one case. Ten patients were treated with metronidazole alone and five with vancomycin. Two patients had recurrent CDI of the pouch during a median follow-up period of 2.9 years and one had CDI refractory to medical management. This patient required diversion of the pouch with an ileostomy for refractory CDI but no patient required excision of the pouch.

CONCLUSION

All 15 patients developing CDI of the pouch were successfully treated with antibiotics and only one required surgery in the form of an ileostomy.

摘要

目的

在结直肠切除术后回肠储袋艰难梭菌感染（CDI）正日益受到关注。我们旨在更好地了解（i）相关危险因素，（ii）治疗方法，以及（iii）溃疡性结肠炎（UC）患者在结直肠切除术后发生储袋CDI后的储袋转流和失败率。

方法

分析2007年至2010年间储袋艰难梭菌检测呈阳性的患者。收集的数据包括患者人口统计学信息、从结直肠切除术到记录的CDI的时间、CDI的治疗方法以及储袋切除率。

结果

在医院CDI数据库记录的2785例患者中，15例接受了结直肠切除回肠储袋肛管吻合术。中位年龄为44岁，从结直肠切除术到首次记录的CDI发作的中位间隔时间为3年。13例（81%）患者在CDI感染前后有多次袋炎发作，且在检测CDI时均有症状。在诊断CDI的30天内，6例（40%）患者正在服用免疫抑制药物，7例（47%）正在服用质子泵抑制剂，12例（80%）接受过抗生素治疗。5例患者因CDI需要住院治疗，4例有严重感染，表现为血清肌酐超过基线值1.5倍（n = 3）和白细胞计数高于15000（n = 1）。6例接受内镜检查的患者有储袋严重炎症，其中1例存在假膜。10例患者仅接受甲硝唑治疗，5例接受万古霉素治疗。在中位随访期2.9年期间，2例患者出现储袋复发性CDI，1例患者的CDI对药物治疗无效。该患者因难治性CDI需要通过回肠造口术进行储袋转流，但没有患者需要切除储袋。