Manthey Carolin F, Dranova Darja, Christner Martin, Berneking Laura, Kluge Stefan, Lohse Ansgar W, Fuhrmann Valentin
First Department of Internal Medicine and Gastroenterology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Ann Intensive Care. 2018 Jan 18;8(1):10. doi: 10.1186/s13613-018-0358-x.
Stool cultures for Campylobacter, Salmonella and Shigella and/or Yersinia spp. are frequently ordered in critically ill patients with diarrhea. The aim of this study is to analyze the diagnostic yield in a large cohort of critically ill patients. Therefore, we performed a cohort study at the Department of Intensive Care Medicine of a University Hospital (11 ICUs).
From all patients who were admitted to the ICU between 2010 and 2015, stool cultures were taken from 2.189/36.477 (6%) patients due to diarrhea. Results of all stool cultures tested for Campylobacter, Salmonella and Shigella and/or Yersinia spp. were analyzed. Overall, 5.747 tests were performed; only six were positive (0.1%). In four of these, Campylobacter spp. were detected; diarrhea started within 48 h after ICU admission. Two patients with Salmonella spp. detection were chronic shedders. On the contrary, testing for Clostridium difficile via GDH- and toxin A/B-EIA yielded positive results in 179/2209 (8.1%) tests and revealed 144/2.189 (6.6%) patients with clinically relevant C. difficile infection.
Stool testing for enteric pathogens other than C. difficile should be avoided in ICU patients and is only reasonable when diarrhea commenced less than 48 h after hospital admission.
对于患有腹泻的重症患者，经常会进行弯曲杆菌、沙门氏菌、志贺氏菌和/或耶尔森菌属的粪便培养。本研究的目的是分析一大群重症患者的诊断率。因此，我们在一家大学医院的重症医学科（11个重症监护病房）进行了一项队列研究。
在2010年至2015年期间入住重症监护病房的所有患者中，因腹泻对2189/36477（6%）的患者进行了粪便培养。对所有检测弯曲杆菌、沙门氏菌、志贺氏菌和/或耶尔森菌属的粪便培养结果进行了分析。总体而言，共进行了5747次检测；只有6次呈阳性（0.1%）。其中4次检测出弯曲杆菌属；腹泻在入住重症监护病房后48小时内开始。两名检测出沙门氏菌属的患者为慢性排菌者。相反，通过谷氨酸脱氢酶和毒素A/B酶免疫测定法检测艰难梭菌，在179/2209（8.1%）的检测中呈阳性结果，显示144/2189（6.6%）的患者患有临床相关的艰难梭菌感染。
重症监护病房患者应避免对除艰难梭菌以外的肠道病原体进行粪便检测，仅在入院后腹泻开始少于48小时时进行检测才合理。
