Osebold W R, Cohen A N, Gillum M D, Hurley J H, Locher N J
St. Luke's Memorial Hospital, Spokane, Washington.
Spine (Phila Pa 1976). 1993 Dec;18(16):2549-52. doi: 10.1097/00007632-199312000-00031.
The authors report two healthy young patients with progressive idiopathic scoliosis, both without allergies or histories of gastrointestinal disorders, who received perioperative preventive cephalosporin antibiotics, and developed explosive diarrhea postoperatively, confirmed as Clostridium difficile pseudomembranous colitis by stool toxin assay. Both patients had initially recovered uneventfully after posterior fusion and Cotrel-Dubousset instrumentation. Their youth, health, diagnosis, and lack of nosocomial factors made colitis unexpected. The two cases were sporadic, occurring 2 years apart over a 12-year observation period. Symptoms and signs of colitis for the two patients were markedly varied as to time of onset, order of appearance, and severity. Unexplained fever before onset of diarrhea led to renewed cephalosporin administration, potentially exacerbating the colitis. Initial symptoms and signs were nonspecific; appropriate treatment had to begin before diagnosis could be confirmed by stool toxin asay, which requires 2 days.
作者报告了两名患有进行性特发性脊柱侧弯的健康年轻患者，两人均无过敏史或胃肠道疾病史，接受了围手术期预防性头孢菌素抗生素治疗，术后出现暴发性腹泻，经粪便毒素检测确诊为艰难梭菌假膜性结肠炎。两名患者最初在后路融合和 Cotrel-Dubousset 器械固定术后均顺利康复。他们的年轻、健康、诊断情况以及缺乏医院感染因素使得结肠炎的发生出乎意料。这两例病例为散发性，在12年的观察期内相隔2年出现。两名患者结肠炎的症状和体征在发病时间、出现顺序和严重程度方面明显不同。腹泻发作前原因不明的发热导致再次使用头孢菌素，这可能加剧了结肠炎。最初的症状和体征不具特异性；在通过粪便毒素检测确诊（这需要2天时间）之前就必须开始适当的治疗。
