Rafey Abdur, Jahan Shah, Farooq Umer, Akhtar Furqana, Irshad Memoona, Nizamuddin Summiya, Parveen Azra
Department of Internal Medicine and Infectious Diseases, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.
Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.
Cureus. 2023 May 15;15(5):e39029. doi: 10.7759/cureus.39029. eCollection 2023 May.
Introduction () is one of the major causes of diarrhea transmitted by the fecal-oral route. type BI/NAP1/027 is responsible for the most severe infection (CDI). It is a major cause of antibiotic-associated diarrhea followed by and Historically, clindamycin, cephalosporins, penicillins, and fluoroquinolones were related to CDI. We conducted this study to evaluate the antibiotics associated with CDI in recent times. Methods We conducted a retrospective, single-center study over a period of eight years. A total of 58 patients were enrolled in the study. Patients with diarrhea and positive toxin in stool were evaluated for antibiotics given, age, presence of malignancy, previous hospital stay for more than three days in the last three months, and any comorbidities. Results Among patients who developed CDI, prior antibiotics for at least four days duration were given in 93% (54/58) of patients. The most common antibiotics associated with infection were piperacillin/tazobactam in 77.60% (45/58), meropenem in 27.60% (16/58), vancomycin in 20.70% (12/58), ciprofloxacin in 17.20% (10/58), ceftriaxone in 16% (9/58), and levofloxacin in 14% (8/58) of patients, respectively. Seven percent (7%) of patients with CDI did not receive any prior antibiotics. Solid organ malignancy was present in 67.20% and hematological malignancy in 27.60% of CDI patients. Ninety-eight percent (98%, 57/58) of patients treated with proton pump inhibitors, 93% of patients with a previous hospital stay for more than three days, 24% of patients with neutropenia, 20.1% of patients aged more than 65 years, 14% of patients with diabetes mellitus, and 12% of patients with chronic kidney disease also developed infection. Conclusion The antibiotics associated with infection are piperacillin/tazobactam, meropenem, vancomycin, ciprofloxacin, ceftriaxone, and levofloxacin. Other risk factors for CDI are proton pump inhibitor use, prior hospital admission, solid organ malignancy, neutropenia, diabetes mellitus (DM), and chronic kidney disease (CKD).
引言 （病原体名称）是经粪-口途径传播的腹泻的主要病因之一。BI/NAP1/027型（病原体名称）导致最严重的（病原体名称）感染（艰难梭菌感染，CDI）。它是抗生素相关性腹泻的主要病因，其次是（其他病原体名称）和（又一病原体名称）。历史上，克林霉素、头孢菌素、青霉素和氟喹诺酮类药物与艰难梭菌感染有关。我们开展这项研究以评估近期与艰难梭菌感染相关的抗生素。方法 我们进行了一项为期八年的回顾性单中心研究。共有58名患者纳入该研究。对有腹泻且粪便中（病原体名称）毒素呈阳性的患者，评估其使用的抗生素、年龄、是否存在恶性肿瘤、过去三个月内是否有超过三天的住院史以及任何合并症。结果 在发生艰难梭菌感染的患者中，93%（54/58）的患者曾使用过至少持续四天的抗生素。与（病原体名称）感染相关最常见的抗生素分别为哌拉西林/他唑巴坦，占77.60%（45/58）；美罗培南，占27.60%（16/58）；万古霉素，占20.70%（12/58）；环丙沙星，占17.20%（10/58）；头孢曲松，占16%（9/58）；左氧氟沙星，占14%（8/58）。7%的艰难梭菌感染患者未使用过任何先前的抗生素。67.20%的艰难梭菌感染患者存在实体器官恶性肿瘤，27.60%存在血液系统恶性肿瘤。98%（57/58）使用质子泵抑制剂的患者、93%过去有超过三天住院史的患者、24%的中性粒细胞减少患者、20.1%年龄超过65岁的患者、14%的糖尿病患者以及12%的慢性肾脏病患者也发生了（病原体名称）感染。结论 与（病原体名称）感染相关的抗生素为哌拉西林/他唑巴坦、美罗培南、万古霉素、环丙沙星、头孢曲松和左氧氟沙星。艰难梭菌感染的其他风险因素包括使用质子泵抑制剂、既往住院、实体器官恶性肿瘤、中性粒细胞减少、糖尿病（DM）和慢性肾脏病（CKD）。
