Jobe B A, Grasley A, Deveney K E, Deveney C W, Sheppard B C
Department of Surgery, Oregon Health Sciences University, Portland, USA.
Am J Surg. 1995 May;169(5):480-3. doi: 10.1016/S0002-9610(99)80199-8.
Colitis caused by Clostridium difficile is receiving increased attention as a nosocomial hospital-acquired infection.
To determine the incidence of C difficile colitis in our facility and the relative proportion of patients dying from the colitis or requiring colectomy for it, we retrospectively reviewed 201 cases of colitis caused by C difficile from 1984 to 1994.
The incidence of C difficile colitis appears to be sharply increasing and is associated with the use of cephalosporins. Among patients who subsequently developed C difficile colitis, the most frequent indication for antibiotic use was perioperative prophylaxis; surgical patients comprised 55% of the total cases. Surgical intervention was required for 5% of patients with C difficile colitis, with an operative mortality of 30%. The overall mortality was 3.5% and was associated with a delay in diagnosis. The only discriminative factor between patients who died and those who survived was length of time from symptoms to treatment--5.43 days for survivors versus 10.7 days for those who died (P < 0.05).
Most cases of C difficile colitis seen by surgeons have followed the use of perioperative prophylactic antibiotics. Strict guidelines for using perioperative antibiotics should be observed. Prompt recognition of C difficile colitis and aggressive therapy for it are essential for a favorable outcome.
艰难梭菌引起的结肠炎作为一种医院获得性感染正受到越来越多的关注。
为确定我院艰难梭菌结肠炎的发病率以及因该结肠炎死亡或需要行结肠切除术的患者的相对比例，我们回顾性分析了1984年至1994年间201例由艰难梭菌引起的结肠炎病例。
艰难梭菌结肠炎的发病率似乎在急剧上升，且与头孢菌素的使用有关。在随后发生艰难梭菌结肠炎的患者中，最常见的抗生素使用指征是围手术期预防；外科患者占总病例数的55%。5%的艰难梭菌结肠炎患者需要手术干预，手术死亡率为30%。总体死亡率为3.5%，且与诊断延迟有关。死亡患者与存活患者之间唯一的判别因素是从症状出现到治疗的时间——存活者为5.43天，死亡者为10.7天（P < 0.05）。
外科医生所见的大多数艰难梭菌结肠炎病例都发生在围手术期预防性使用抗生素之后。应遵守严格的围手术期抗生素使用指南。及时识别艰难梭菌结肠炎并积极治疗对取得良好预后至关重要。
