Teja Bijan, Alibhai Nafeesa, Rubenfeld Gordon D, Taggart Linda R, Jivraj Naheed, Hirji Sameer A, O'Gara Brian P, Shaefi Shahzad
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5B 1T8, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
Infect Dis Rep. 2021 Jan 1;13(1):18-22. doi: 10.3390/idr13010003.
While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from (formerly ) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.0% (95% CI, 12.1-18.3%) of patients with extreme leukocytosis and diarrhea and that mortality for those with CDI, diarrhea, and extreme leukocytosis was 33.8% (95% CI, 23.2-44.3%). These data support consideration of empiric treatment for CDI in unstable critically ill patients with extreme leukocytosis and diarrhea, along with treatment of other possible sources of sepsis as appropriate. Empiric treatment for CDI can usually be discontinued promptly, along with narrowing of other broad-spectrum antimicrobial coverage, if a sensitive test is negative.
虽然早期经验性抗生素治疗对脓毒症患者有益，但艰难梭菌感染（CDI，原称难辨梭状芽孢杆菌感染）所致脓毒症在大型队列研究中尚未得到充分研究。我们试图确定在8659名入住重症监护病房的患者队列中，白细胞极度增多与腹泻的组合是否能强烈预测CDI。我们发现，白细胞极度增多且腹泻的患者中，15.0%（95%可信区间，12.1 - 18.3%）存在CDI，且CDI、腹泻及白细胞极度增多患者的死亡率为33.8%（95%可信区间，23.2 - 44.3%）。这些数据支持对白细胞极度增多且腹泻的不稳定重症患者考虑进行CDI的经验性治疗，并酌情治疗脓毒症的其他可能来源。如果艰难梭菌检测呈阴性，CDI的经验性治疗通常可迅速停止，同时缩小其他广谱抗菌药物的覆盖范围。
