Grube B J, Heimbach D M, Marvin J A
Arch Surg. 1987 Jun;122(6):655-61. doi: 10.1001/archsurg.1987.01400180037007.
We followed up 112 patients in the University of Washington Burn Center, Seattle, for the development of Clostridium difficile diarrhea. Diarrhea developed in 20 patients with a mean burn size of 42%, mean age of 38 years, and 49 mean total antibiotic days, for an incidence of 17%. Eleven patients had 16 episodes of nonspecific diarrhea. Nine patients had 11 episodes of C difficile-positive diarrhea and 15 episodes of nonspecific diarrhea for an incidence of 45% of all patients with diarrhea. There were no differences in patient age, burn size, or length of stay between the groups. When the 31 episodes of nonspecific diarrhea were compared with the 11 episodes of C difficile diarrhea, there were no differences between the groups in temperature, albumin levels, or total number of antibiotic days preceding the episodes of diarrhea. The only significant finding that differed between the two types of diarrhea was the white blood cell count on the day of diagnosis. The nonspecific diarrhea was self-limited, requiring antimotility agents in 45% of the episodes. The C difficile diarrhea responded promptly to vancomycin hydrochloride, with resolution of symptoms in an average of 3.3 days. There were two recurrences, and both responded to a second course of vancomycin.
我们对西雅图华盛顿大学烧伤中心的112名患者进行了随访，以观察艰难梭菌性腹泻的发生情况。20名患者出现腹泻，平均烧伤面积为42%，平均年龄为38岁，平均使用抗生素总天数为49天，发病率为17%。11名患者出现16次非特异性腹泻。9名患者出现11次艰难梭菌阳性腹泻和15次非特异性腹泻，在所有腹泻患者中的发病率为45%。两组患者在年龄、烧伤面积或住院时间方面没有差异。将31次非特异性腹泻与11次艰难梭菌腹泻进行比较时，两组在腹泻发作前的体温、白蛋白水平或抗生素使用总天数方面没有差异。两种类型腹泻之间唯一显著的差异是诊断当天的白细胞计数。非特异性腹泻是自限性的，45%的发作需要使用止泻药。艰难梭菌腹泻对盐酸万古霉素反应迅速，症状平均在3.3天内缓解。有两例复发，均对第二疗程的万古霉素有反应。
