Case-control Analysis ofClostridium difficile—Associated Diarrhea on a Gynecologic Oncology Service

[摘要] Objective:The incidence, morbidity, and risk factors associated withClostridium difficile-associateddiarrhea (CDAD) were studied in a group of gynecologic oncology patients.Methods:A case-control analysis of gynecologic oncology patients with CDAD was carried outfrom August 1986 through January 1989 in a university medical center.Results:One hundred twenty-three stool samples were tested forC. difficileusing the CDT latexagglutination test (Marion Diagnostics, Kansas City, MO). Thirty episodes of CDAD developed in23 patients. From August 1986 through July 1988, the incidence was stable at 1.5 episodes/100admissions. From August 1988 through January 1989, the incidence increased to 9.9 episodes/100admissions (P= 0.005). Compared with patients with nonspecific antibiotic-associated diarrhea, thestudy patients were hospitalized longer prior to the development of symptoms (mean 15.2 vs. 9.2days,P= 0.006) and were admitted more frequently with diarrhea (37% vs. 11%,P= 0.015). Therates of surgery, chemotherapy, and radiation therapy were similar. Fever (57% vs. 14%,P< 0.001),abdominal pain (40% vs. 6%,P< 0.001), bloody stools (27% vs. 3%,P= 0.006), and leukocytosis(64% vs. 26%,P= 0.011) were more common among the study cases. The duration, indication, andnumber of antibiotics administered were similar, though once started, the mean time to symptomswas longer in the study cases (13.7 vs. 6.1 days,P= 0.004). Seven relapses, 1 death, and 1 unplannedcolostomy occurred among women with CDAD.Conclusions: C. difficileis a serious cause of nosocomial morbidity in gynecologic oncologypatients. Diarrhea developing after antibiotic exposure is more likely to be associated withC. difficilein patients whose symptoms develop several days after completing antibiotics and in patients with ahistory of CDAD.

[学科分类] 妇产科学