Clostridium colitis at a surgical department
Authors:
L. Urbánek 1; I. Čapov 1; J. Cagaš 1; R. Tejkalová 2; J. Kratochvílová 3
Authors place of work:
I. chirurgická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice u svaté Anny v Brně
přednota: Prof. MUDr. I. Čapov, CSc.
1; Mikrobiologický ústav Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice u svaté Anny
v Brně, přednota: Doc. MUDr. F. Růžička, Ph. D.
2; Oddělení hygieny a epidemiologie Fakultní nemocnice u svaté Anny v Brně
vedoucí oddělení MUDr. J. Kratochvílová
3
Published in the journal:
Rozhl. Chir., 2014, roč. 93, č. 2, s. 70-75.
Category:
Original articles
Práce je věnována prof. MUDr. Janu Wechslerovi u příležitosti jeho 75. narozenin.
Summary
Introduction:
The aim of our study was to identify risk factors associated with the development of Clostridium difficile colitis and determining the severity of clostridial colitis in a group of surgical patients. Identification of its predispositions is necessary for preventive interventions and effective treatment.
Material and methods:
51 patients diagnosed with clostridial colitis were included in our study. The inclusion criterion was based on laboratory detection of clostridial toxin in each patient. We analysed age, concomitant malignancy, recent surgical intervention, antibiotic and proton pump inhibitors treatment. The severity of clostridial colitis and its correlation to possible risk factors mentioned above was described and statistically evaluated. Non-parametric Fischer test was used for the statistical evaluation.
Results:
We confirmed the importance of potential risk factors in the evaluated group of surgical patients with Cl. difficile colitis. The course of the disease was described as serious in 39.2% of patients in the study group. Recurrent attack of colitis was diagnosed in 4 patients, in 2 of them the second recurrence, in 1 patient the third relapse occurred. 2 patients with clostridial colitis evaluated in our group died, but the relation of their death to the clostridial GIT infection was not causal and the primary cause of death in both of them was multiple organ failure caused by serious comorbidities. We did not indicate any surgical intervention and no toxic megacolon developed in our study group. We did not detect any statistical correlation between the described risk factors and the severity of colitis.
Conclusion:
Clostridium difficile colitis needs to be recognised as a serious complication, especially in hospitalised patients. Its increased frequency and severity should not be underestimated. Although we can identify potential risk factors, we cannot exclude some of them completely (e.g. antibiotic and PPI treatment). On the other hand, a rational approach to antibiotic treatment in particular can be helpful in reducing the frequency and severity of clostridium difficile colitis.
Key words:
clostridium colitis – Clostridium difficile – risk factors
Zdroje
1. Beneš J, Husa P, Nyč O. Doporučený postup diagnostiky a léčby kolitidy vyvolané Clostridium difficile. Klin mikrobiol inf lék 2012;18:160–167.
2. Dalton BR, et al. Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low–endemicity, non–outbreak hospital setting. AP&T’s 2009;29:626–634.
3. Bauer, Martijn P, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011;377:63–73.
4. Bauer MP, Kuijper EJ, and Van Dissel JT. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment guidance document for Clostridium difficile infection (CDI). Clin Microbiol Infect 2009;15:1067–1079.
5. Cohen, Stuart H, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp 2010;31:431–455.
6. Louie, Thomas J, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–431.
7. Linsky A, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med 2010;170: 772–778.
8. Pant C, Madonia P, Minocha A. Does PPI therapy predispose to Clostridium difficile infection? Nat Rev Gastroenterol Hepatol 2009;6:555–557.
9. Owens RC, et al. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46,Supplement 1:S19–S31.
10. Vojtilová L, Husa P, Svoboda R. Kolitida vyvolaná Clostridium difficile – rizikové faktory, hypervirulentní kmen a nové terapeutické možnosti. Gastroent Hepatol 2009;63:180–185.
11. Beneš J. Kolitida vyvolaná Clostridium difficile. Infekční lékařství. 1. vyd. Praha, Galén 2009:271–73.
12. Dial S, et al. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case–control studies. Can Med Assoc J 2004;171:33–38.
13. Zar FA, et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile–associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302–307.
14. Kuijper EJ, van Dissel JT, Wilcox MH. Clostridium difficile: changing epidemiology and new treatment options. Curr Opin Infect Dis 2007;20:376–383.
15. Pepin J, Saheb N, Coulombe MA, Alary ME, Corriveau MP, Authier S, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.
16. Kim MJ, et al. Risk factors for the development of Clostridium difficile colitis in a surgical ward. J. Korean Surg. Soc. 2012;83: 14–20.
17. Krapohl GL, et al. Bowel preparation for colectomy and risk of Clostridium difficile infection. Dis Colon Rectum 2011;54: 810–817.
18. Yeom,ChH, et al. Risk factors for the development of Clostridium difficile-associated colitis after colorectal cancer surgery. J Korean Soc of Coloproctol 2010;26: 329–333.
19. Sailhamer EA, et al. Fulminant Clostridium difficile colitis: patterns of care and predictors of mortality. Arch Surg 2009;144: 433–439.
20. Valiquette L, Cossette B, Garant MP, Diab H, Pepin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45 (Suppl 2):S112–121.
21. Nyč O. Přístup k léčbě střevních infekcí způsobených bakterií Clostridium difficile. Klin Mikrobiol Inf Lek 2010;16:93–96.
22. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40:1–15.
23. Kelly CP, Pothoulakis CH, LaMont JT. Clostridium difficile colitis. N Engl J Med 1994;330:257–262.
24. Rubin MS,Bodenstein LE. Severe Clostridium difficile colitis. Dis Colon Rectum 1995;38:350–354.
25. Henrich TJ, et al. Clinical risk factors for severe Clostridium difficile–associated disease. Emerg Infect Dis 2009;15:415–422.
26. Greenstein AJ, et al. Risk factors for the development of fulminant Clostridium difficile colitis. Surg 2008;143:623–629.
27. Fekety R, et al. Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 1997;24: 324–333.
Štítky
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