Saha Srishti, Yadav Devvrat, Pardi Ryan, Patel Robin, Khanna Sahil, Pardi Darrell
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Therap Adv Gastroenterol. 2021 Oct 8;14:17562848211050443. doi: 10.1177/17562848211050443. eCollection 2021.
Polymerase chain reaction (PCR) is a sensitive test for diagnosing infection (CDI) and could remain positive following resolution of CDI. The kinetics of PCR positivity following antibiotics for CDI is unknown. We studied this and whether it predicted CDI recurrence.
Adults with CDI from October 2009 to May 2017 were included. Serial stool samples within 60 days of treatment were collected. Recurrent CDI was defined as diarrhea after interim symptom resolution with positive stool PCR within 56 or 90 days of treatment completion. Contingency table analysis was used to assess the risk of recurrence.
Fifty patients were included [median age: 51 (range = 20-86) years, 66% women]. Treatment given was metronidazole, 50% (25); vancomycin, 44% (22); both, 4% (2); and fidaxomicin, 2% (1). Median duration of treatment for all 50 patients was 14 (range = 8-60) days. The median duration of treatment in patients who got prolonged therapy (>14 days) ( = 10) was 47 (range = 18-60) days. Median time to negative PCR was 9 (95% CI, 7-14) days from treatment initiation, which did not differ by antibiotics given ( = 0.5). A positive PCR during or after treatment was associated with a higher risk of recurrence at 56 days ( = 0.02) and at 90 days ( = 0.009).
The median time to negative PCR in CDI was 9 days from treatment initiation. The PCR positivity during or after treatment may be useful for recurrence prediction; larger studies are needed to validate these results.
聚合酶链反应（PCR）是诊断艰难梭菌感染（CDI）的一项敏感检测方法，且在CDI症状缓解后PCR结果可能仍为阳性。CDI患者接受抗生素治疗后PCR阳性的动态变化情况尚不清楚。我们对此进行了研究，并探讨其是否可预测CDI复发。
纳入2009年10月至2017年5月期间患有CDI的成年患者。收集治疗60天内的系列粪便样本。复发性CDI定义为在治疗中期症状缓解后，在治疗完成后56天或90天内粪便PCR呈阳性且出现腹泻。采用列联表分析评估复发风险。
共纳入50例患者[中位年龄：51（范围=20-86）岁，66%为女性]。给予的治疗药物为甲硝唑，50%（25例）；万古霉素，44%（22例）；两者联合使用，4%（2例）；非达霉素，2%（1例）。所有50例患者的中位治疗持续时间为14（范围=8-60）天。接受延长治疗（>14天）的患者（n=10）的中位治疗持续时间为47（范围=18-60）天。从治疗开始至PCR结果转为阴性的中位时间为9（95%CI，7-14）天，不同抗生素治疗组之间无差异（P=0.5）。治疗期间或治疗后PCR呈阳性与56天时（P=0.02）和90天时（P=0.009）较高的复发风险相关。
CDI患者从治疗开始至PCR结果转为阴性的中位时间为9天。治疗期间或治疗后PCR阳性可能有助于预测复发；需要更大规模的研究来验证这些结果。
