Grigorescu Bianca-Liana, Fodor Raluca Ştefania, Cioc Adrian Dan, Veres Mihaly, Orlandea Monica, Lăzescu Bogdan, Almasy Emoke
University of Medicine and Pharmacy of Tîrgu Mureş, 38 Gheorghe Marinescu street, Tîrgu Mureş, 540139, Romania.
County Clinical Emergency Hospital Tîrgu Mureş, Romania, 50 Gheorghe Marinescu street, Tîrgu Mureş, 540139, Romania.
J Crit Care Med (Targu Mures). 2016 Feb 9;2(1):38-43. doi: 10.1515/jccm-2016-0006. eCollection 2016 Jan.
Clostridium difficile, an anaerobic, spore-forming, toxin-forming, gram-positive bacillus present in the bacterial flora of the colon is the principal cause of nosocomial diarrhoea in adults.
Assessment of favouring factors of Clostridium difficile infections as well as the interactions between them, in critically ill hospitalized patients undergoing complex medical and surgical treatments.
A retrospective case-control study involving eighty patients admitted in the Intensive Care Unit (ICU) of the County Clinical Emergency Hospital Tîrgu-Mureş was conducted between January and October 2014. Patients aged eighteen years and over, who had undergone complex medical and surgical treatment, were divided into two subgroups. Group 1 included patients who developed diarrhoea but were not diagnosed as having a Clostridium difficile infection (CDI). Group 2 included patients who developed diarrhoea due to CDI as indicated by a positive culture and the expression of exotoxin. The assessed parameters were age, length of stay (LOS), antibiotic spectrum, association with proton pump inhibitors (PPI) or H2-receptor antagonists, immunological status, the presence or lack of gastrointestinal tract surgery.
The mean age was 64.6 years with an average LOS of 10 days. Fifty-six percent of patients came to the ICU from internal medicine wards and forty-three percent from surgical wards. 20.5% of them were immunosuppressed. Co-association of ceftriaxone and pantoprazole significantly increased the risk of CDI compared to co-administration of any other antibiotic or pantoprazole (p=0.01). The odds ratio for Pantoprazole together with any antibiotic versus antibiotic therapy alone was significantly higher (p=0.018) with a sevenfold increase in the risk of positive exotoxin increase.
Antibiotic use is associated with "no risk to develop CDI" in the first five days of administration. PPIs associated therapy increased the risk of CDI in first seventy-two hours regardless of the antibiotic type, and contributes to an active expression of CD exotoxin.
艰难梭菌是一种存在于结肠菌群中的厌氧、产芽孢、产毒素的革兰氏阳性杆菌，是成人医院获得性腹泻的主要原因。
评估重症住院患者在接受复杂内科和外科治疗过程中艰难梭菌感染的有利因素及其相互作用。
2014年1月至10月在特尔古穆列什县临床急救医院重症监护病房（ICU）对80例患者进行了一项回顾性病例对照研究。18岁及以上接受复杂内科和外科治疗的患者被分为两个亚组。第1组包括出现腹泻但未被诊断为艰难梭菌感染（CDI）的患者。第2组包括因CDI导致腹泻的患者，其粪便培养阳性且外毒素呈阳性。评估的参数包括年龄、住院时间（LOS）、抗生素种类、是否联用质子泵抑制剂（PPI）或H2受体拮抗剂、免疫状态、是否进行过胃肠道手术。
平均年龄为64.6岁，平均住院时间为10天。56%的患者从内科病房转入ICU，43%从外科病房转入。其中20.5%的患者免疫功能低下。与使用任何其他抗生素或泮托拉唑联用相比，头孢曲松与泮托拉唑联用显著增加了CDI的风险（p=0.01）。泮托拉唑与任何抗生素联用相对于单独使用抗生素治疗的优势比显著更高（p=0.018），外毒素阳性风险增加了7倍。
抗生素使用在给药的前五天与“发生CDI无风险”相关。无论抗生素类型如何，PPI联用治疗在最初72小时内增加了CDI的风险，并促进了CD外毒素的活性表达。
