Rodríguez-Varón A, Muñoz O M, Pulido-Arenas J, Amado S B, Tobón-Trujillo M
Departamento de Medicina Interna, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
Departamento de Medicina Interna, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia.
Rev Gastroenterol Mex. 2017 Apr-Jun;82(2):129-133. doi: 10.1016/j.rgmx.2016.10.003. Epub 2017 Mar 18.
Evidence in Colombia and Latin America has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (AAD). The present study attempts to describe the clinical characteristics of patients with AAD and to determine the presence of Clostridium difficile, utilizing the polymerase chain reaction (PCR) technique.
Forty-three patients with AAD, managed at the Hospital Universitario San Ignacio in Bogotá, Colombia, were evaluated. Prospective patient information was collected, with respect to demographic characteristics, profile of the antibiotic management received, clinical manifestations, risk factors, and paraclinical reports. In addition, the real time PCR test for Clostridium difficile (Cepheid Xpert, Sunnyvale, CA, United States) was performed.
Patient mean age was 58 years (19.31 SD). The majority of the patients received 2 or more antibiotics (62.9%) and the beta-lactams were the most frequently used. Hospital stay ranged from 2 to 104 days with a median of 10 days. The most frequent clinical manifestations were abdominal pain and bloating, followed by fever and tachycardia. At the time of diagnosis, 23 patients had noninflammatory results in the stool sample analyses and 18 had kidney failure. The mean level of albumin was 2.4mg/dl (0.7 SD). The presence of Clostridium difficile was documented through PCR in 6 patients (13.95% of the cases).
AAD patients were characterized by a high frequency of severe comorbidities and prolonged hospital stay. The presence of Clostridium difficile in only 13.9% of the cases suggests that other causes of diarrhea in the hospitalized patient should be considered.
在哥伦比亚和拉丁美洲，尚无足够证据用以确定抗生素相关性腹泻（AAD）患者的临床特征。本研究旨在描述AAD患者的临床特征，并利用聚合酶链反应（PCR）技术确定艰难梭菌的存在情况。
对在哥伦比亚波哥大圣伊格纳西奥大学医院接受治疗的43例AAD患者进行了评估。收集了患者的前瞻性信息，包括人口统计学特征、接受的抗生素治疗情况、临床表现、危险因素及辅助检查报告。此外，还进行了艰难梭菌的实时PCR检测（美国加利福尼亚州森尼韦尔市 Cepheid Xpert）。
患者平均年龄为58岁（标准差19.31）。大多数患者接受了2种或更多种抗生素治疗（62.9%），其中β-内酰胺类抗生素使用最为频繁。住院时间为2至104天，中位数为10天。最常见的临床表现为腹痛和腹胀，其次是发热和心动过速。诊断时，23例患者粪便样本分析结果为非炎症性，18例患者出现肾衰竭。白蛋白平均水平为2.4mg/dl（标准差0.7）。通过PCR检测发现6例患者存在艰难梭菌（占病例的13.95%）。
AAD患者的特点是严重合并症发生率高且住院时间延长。仅13.9%的病例中存在艰难梭菌，这表明应考虑住院患者腹泻的其他病因。
