Finnerty Celeste C, Herndon David N, Lee Jong O, Rodriguez Noe A, Al-Haj Iman H, Wurzer Paul, Calhoun Brendan R, Jeschke Marc G
Shriners Hospitals for Children, Galveston, Texas.
Sealy Center for Molecular Medicine and the Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas.
Surgery. 2016 Jun;159(6):1631-1637. doi: 10.1016/j.surg.2016.01.004. Epub 2016 Mar 25.
Clostridium difficile is a key culprit underlying nosocomial infectious diarrhea. We investigated the effect of C difficile-associated diarrhea (CDAD) on morbidity and mortality in severely burned children and CDAD risk factors.
After review of 2,840 records, 288 pediatric burn patients were identified as having stool output of >10 mL•kg(-1)•min(-1) for ≥2 successive days and had stool samples immunoassayed for toxins A and B. A case control analysis was performed by matching cases to controls via logistic regression and propensity scores so that age, admission time, and time of occurrence could be controlled; the endpoints were mortality and hospitalization time.
Eighteen patients tested positive for C difficile toxins (median age, 4 years; mean total body surface area burned, 59%). In the CDAD group, unadjusted in-hospital mortality was 28% (odds ratio, 5.4; 95% CI, 1.7-16.7; P = .01). Hospitalization averaged 48 days in the CDAD group and 38 days in the non-CDAD group (P = .24). Duration of stay per percent total body surface area burned was greater in the CDAD group (0.82 ± 0.4 vs 0.60 ± 0.4; P = .03), as were prolonged bouts of diarrhea complicated by acidosis (13 ± 16 vs 4 ± 5 days; P < .005). Of the 18 possible risk factors evaluated, inhalation injury diagnosed at admission occurred more often in CDAD patients than matched controls (59% vs 31%; P = .04).
CDAD during hospitalization is associated with greater mortality after burns. Inhalation injury increases the likelihood of C difficile infection. Whether C difficile infection is an indication of greater illness among certain burned patients is unknown.
艰难梭菌是医院感染性腹泻的主要致病菌。我们研究了艰难梭菌相关性腹泻（CDAD）对严重烧伤儿童发病率和死亡率的影响以及CDAD的危险因素。
在查阅2840份记录后，确定288例儿科烧伤患者连续2天以上粪便排出量>10 mL•kg⁻¹•min⁻¹，并对粪便样本进行毒素A和毒素B免疫测定。通过逻辑回归和倾向评分将病例与对照进行匹配，进行病例对照分析，以便控制年龄、入院时间和发病时间；终点指标为死亡率和住院时间。
18例患者艰难梭菌毒素检测呈阳性（中位年龄4岁；平均烧伤总面积59%）。在CDAD组中，未调整的院内死亡率为28%（比值比，5.4；95%可信区间，1.7 - 16.7；P = 0.01）。CDAD组平均住院时间为48天，非CDAD组为38天（P = 0.24）。CDAD组每百分比烧伤总面积的住院时间更长（0.82±0.4对0.60±0.4；P = 0.03），伴有酸中毒的腹泻持续时间延长情况也是如此（13±16对4±5天；P < 0.005）。在评估的18个可能危险因素中，入院时诊断的吸入性损伤在CDAD患者中比匹配的对照组更常见（59%对31%；P = 0.04）。
住院期间的CDAD与烧伤后更高的死亡率相关。吸入性损伤增加了艰难梭菌感染的可能性。艰难梭菌感染是否表明某些烧伤患者病情更严重尚不清楚。
