Dolcé P, Gourdeau M, April N, Bernard P M
Department of Microbiology, Hôpital de l'Enfant-Jésus, Québec, Canada.
Am J Infect Control. 1995 Feb;23(1):34-9. doi: 10.1016/0196-6553(95)90006-3.
An outbreak of hemorrhagic proctocolitis occurred after the introduction of 2% glutaraldehyde as a disinfectant for colonoscopes. An inadequate rinsing procedure was detected. Recent studies have pointed to glutaraldehyde as an irritant potentially capable of inducing colitis. This study aimed to measure retrospectively the occurrence of proctocolitis after colonoscopy in persons exposed to glutaraldehyde used as a disinfectant for colonoscopes, and to compare this rate with that in patients exposed to the previous cleaning procedure.
Colonoscopic procedures were randomly selected during the period when glutaraldehyde was used, as well as during the previous period, when a detergent was used. Patients were asked to respond to a questionnaire during a telephone interview, in search of symptoms compatible with proctocolitis after colonoscopy.
Of the 400 colonoscopic procedures selected during each of the glutaraldehyde and the detergent periods, respectively 299 and 242 were evaluable. According to different nonexclusive definitions, we observed in the glutaraldehyde period higher frequencies of proctocolitis (at least five stools/day; 14/299 vs 3/242, p = 0.02), severe proctocolitis (> 10 stools/day; 10/299 vs 1/242, p = 0.04), and severe hemorrhagic proctocolitis (6/299 vs 0/242, p = 0.04). Younger age was associated with proctocolitis only during the glutaraldehyde period (p = 0.0008). No pathogen was demonstrated in the only two patients who had stool cultures. The median incubation after colonoscopy was 4 hours (range 0 to 24 hours) and the symptoms lasted 30 hours (range 6 to 216 hours). No patient had fever, and the illness resolved spontaneously in all cases.
Inadequate rinsing of colonoscopes after immersion in glutaraldehyde may result in proctocolitis, presumably caused by direct action on the mucosa.
在将2%戊二醛用作结肠镜消毒剂后，发生了出血性直肠结肠炎的暴发。检测到冲洗程序不充分。最近的研究指出戊二醛是一种潜在的能够诱发结肠炎的刺激物。本研究旨在回顾性测量接触用作结肠镜消毒剂的戊二醛的人群在结肠镜检查后直肠结肠炎的发生率，并将该发生率与接触先前清洗程序的患者的发生率进行比较。
在使用戊二醛期间以及之前使用清洁剂期间，随机选择结肠镜检查程序。在电话访谈中要求患者对问卷做出回应，以寻找与结肠镜检查后直肠结肠炎相符的症状。
在戊二醛和清洁剂使用期间分别选择的400例结肠镜检查程序中，分别有299例和242例可进行评估。根据不同的非排他性定义，我们观察到在戊二醛期间直肠结肠炎的发生率更高（每天至少5次大便；14/299对3/242，p = 0.02）、严重直肠结肠炎（每天大便>10次；10/299对1/242，p = 0.04）以及严重出血性直肠结肠炎（6/299对0/242，p = 0.04）。仅在戊二醛期间，年龄较小与直肠结肠炎相关（p = 0.0008）。在仅有的两名进行粪便培养的患者中未发现病原体。结肠镜检查后的中位潜伏期为4小时（范围0至24小时），症状持续30小时（范围6至216小时）。没有患者发烧，所有病例病情均自发缓解。
结肠镜在戊二醛中浸泡后冲洗不充分可能导致直肠结肠炎，推测是由对黏膜的直接作用引起的。
