Service d'Hygiène, Épidémiologie Infectiovigilance et Prévention, Groupement Hospitalier Centre, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437, Lyon Cedex 03, France.
Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut national de la santé et de la recherche médicale U1111, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard 1, Lyon, France.
Eur J Clin Microbiol Infect Dis. 2018 Nov;37(11):2123-2130. doi: 10.1007/s10096-018-3348-x. Epub 2018 Aug 17.
Clostridium difficile infection (CDI) produces a variety of clinical presentations ranging from mild diarrhea to severe infection with fulminant colitis, septic shock, and death. CDI puts a heavy burden on healthcare systems due to increased morbidity and mortality, and higher costs. We evaluated the clinical impact of CDI in terms of complications and mortality in a French university hospital compared with patients with diarrhea unrelated to CDI. A 3-year prospective, observational, cohort study was conducted in a French university hospital. Inpatients aged 18 years or older with CDI-suspected diarrhea were eligible to participate in the study and were followed for up to 60 days after CDI testing. Among the 945 patients with diarrhea included, 233 had confirmed CDI. Overall, 106 patients (11.2%) developed at least one of the following complications: colectomy, colitis, ileitis/rectitis, ileus, intestinal perforation, megacolon, multiorgan failure, pancolitis, peritonitis, pseudomembranous colitis, renal failure, and sepsis/septic shock. The complication rate was significantly higher in patients with diarrhea related to C. difficile than in non-CDI patients (26.6% vs 6.2%, P < 0.001). At day 60, 137 (14.5%) patients had died, with 37 deaths among the CDI group (15.9%). Death was attributable to CDI in 15 patients (6.4%). Complications are more frequent among CDI cases than in patients with diarrhea not related to C. difficile. Assessment of CDI is necessary to ensure allocation of sufficient resources to CDI prevention.
艰难梭菌感染（CDI）可引起多种临床表现，从轻到重包括腹泻、暴发性结肠炎、感染性休克和死亡。由于发病率和死亡率增加，以及成本更高，CDI 给医疗系统带来了沉重负担。我们评估了法国一家大学附属医院中 CDI 患者的并发症和死亡率对临床的影响，并与非 CDI 腹泻患者进行了比较。这是一项为期 3 年的前瞻性、观察性队列研究，在法国一家大学附属医院进行。年龄在 18 岁或以上、疑似 CDI 腹泻的住院患者有资格参加研究，并在 CDI 检测后随访 60 天。在纳入的 945 例腹泻患者中，233 例确诊为 CDI。总的来说，106 例（11.2%）患者出现了以下至少一种并发症：结肠切除术、结肠炎、回肠炎/直肠炎、肠梗阻、肠穿孔、巨结肠、多器官衰竭、全结肠炎、腹膜炎、伪膜性结肠炎、肾衰竭和脓毒症/感染性休克。与非 CDI 患者相比，与艰难梭菌相关的腹泻患者的并发症发生率显著更高（26.6%比 6.2%，P<0.001）。在第 60 天，137 例（14.5%）患者死亡，其中 CDI 组有 37 例死亡（15.9%）。15 例（6.4%）死亡归因于 CDI。CDI 病例比非 CDI 腹泻患者更常出现并发症。需要评估 CDI，以确保为 CDI 预防分配足够的资源。
