Paláu-Dávila Laura, Garza-González Elvira, Gutiérrez-Delgado Eva María, Camacho-Ortiz Adrián
Servicio de Infectología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
Servicio de Gastroenterología, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, 64460, Monterrey, Mexico.
Indian J Gastroenterol. 2017 Jan;36(1):38-42. doi: 10.1007/s12664-016-0722-4. Epub 2016 Dec 17.
Factors associated with complicated Clostridium difficile infection (CDI) may vary among populations, and predictors of severe outcomes in CDI have not been studied in Hispanic patients. The aim of this study was to identify factors associated with a higher risk of colectomy, all-cause mortality, and CDI-associated mortality in a Hispanic population.
We performed a retrospective study of all hospitalized patients with a diagnosis of CDI between January 1, 2011 and September 30, 2015 in a 450-bed teaching hospital in Monterrey, northeast Mexico. Three main outcomes were defined: fulminant colitis with subsequent colectomy, all-cause mortality within 30 days of diagnosis, and CDI-attributable mortality.
Of 261 patients with diarrhea, 176 were diagnosed with CDI. For colectomy, Charlson comorbidity index, ICU stay and mechanical ventilation prior to CDI diagnosis, days with diarrhea prior to treatment, total days of hospital stay and days after CDI diagnosis, elevated ATLAS score, days of diarrhea post CDI treatment, and treatment failure significantly predicted the necessity of surgical treatment with colectomy.
Treatment failure, persistent diarrhea, and a high ATLAS score were identified as risk factors for severe outcomes of CDI. A low albumin concentration and high creatinine were associated with higher overall mortality.
与复杂性艰难梭菌感染（CDI）相关的因素在不同人群中可能有所不同，而西班牙裔患者中CDI严重结局的预测因素尚未得到研究。本研究的目的是确定西班牙裔人群中与结肠切除术、全因死亡率和CDI相关死亡率风险较高相关的因素。
我们对2011年1月1日至2015年9月30日期间在墨西哥东北部蒙特雷一家拥有450张床位的教学医院住院诊断为CDI的所有患者进行了回顾性研究。定义了三个主要结局：暴发性结肠炎伴随后的结肠切除术、诊断后30天内的全因死亡率以及CDI归因死亡率。
在261例腹泻患者中，176例被诊断为CDI。对于结肠切除术，Charlson合并症指数、CDI诊断前的ICU住院时间和机械通气、治疗前腹泻天数、住院总天数和CDI诊断后的天数、升高的ATLAS评分、CDI治疗后腹泻天数以及治疗失败显著预测了结肠切除术手术治疗的必要性。
治疗失败、持续性腹泻和高ATLAS评分被确定为CDI严重结局的危险因素。低白蛋白浓度和高肌酐与较高的总体死亡率相关。
