Clostridium-difficile-assoziierte Infektionen in der septischen Unfallchirurgie: Eine Analyse von 159 Patienten

Zusammenfassung

Hintergrund: Clostridium-difficile-assoziierte Erkrankungen stellen schwerwiegende nosokomiale Erkrankungen dar. In letzter Zeit wurde über einen dramatischen Anstieg der Häufigkeit von Clostridium-difficile-assoziierten Erkrankungen berichtet. Derzeit existieren keine Studien, welche die Häufigkeit dieser Erkrankung auf einer septischen Station einer unfallchirurgischen Klinik analysieren. Ziel der vorliegenden Arbeit war es unter anderem, die Häufigkeit sowie weitere Faktoren des Krankheitsbilds herauszuarbeiten. Material und Methoden: Alle Patienten, die im Zeitraum von Januar 2002 bis Dezember 2009 auf der septischen Station der unfallchirurgischen Klinik behandelt wurden und während des stationären Aufenthalts eine Clostridium-assoziierte Diarrhö oder eine pseudomembranöse Kolitis entwickelten, wurden in die Studie eingeschlossen. Neben den demografischen Daten wurden folgende Faktoren untersucht: Zusammenhang der Inzidenz bezogen auf Alter, Geschlecht und verabreichte Antibiotika. Ergebnisse: Insgesamt entwickelten 159 Patienten (2,5 %) während des stationären Aufenthalts eine Clostridium-difficile-assoziierte Diarrhö, wobei sich die Häufigkeit der Clostridium-assoziierten Infektion im Jahre 2009 verglichen zu 2002 oder 2003 mehr als vervierfacht hat. Patienten über 65 Jahre entwickelten im Vergleich zu Patienten jünger als 65 Jahre häufiger eine Clostridium-difficile-assoziierte Infektion (OR 1,96; 95 %-Konfidenzintervall 1,4–2,7). Keine signifikanten Unterschiede gab es zwischen beiden Geschlechtern und zwischen Mehrfach-Antibiotikatherapie und Einfach-Antibiotikatherapie. Schlussfolgerung: Schlussfolgernd sind Clostridium-difficile-assoziierte Erkrankungen ein häufiger werdendes Krankheitsbild in der septischen Unfallchirurgie.

Abstract

Background: Clostridium difficile-associated infections are severe nosocomial infections. In recent studies, dramatic increases of CD-associated infections for the U. S. A. and Germany have been described, which leads to additional risk for patients and higher costs. Despite several studies, there is no study available which analyses the incidence of CD-associated infections on a septic ward at a level 1 trauma centre. Therefore, this study was performed to analyse the incidence and risk factors of developing a CD-associated infection in septic trauma patients. Material and Methods: All patients treated between January 2002 and December 2009 at the septic ward of a level 1 trauma centre, who developed a CD-associated diarrhoea or pseudomembranous colitis, were included in this retrospective study. Information about age, sex, admission diagnosis, indication for antibiotic therapy, length of antibiotic therapy, number of administered antibiotics, length of hospital stay, type of treatment of the CD-associated infection as well as the mortality rate was gleaned from the patients' medical records. Furthermore, the relation of developing a CD-associated infection was determined for the following factors: (i) age > 65 years versus < 65 years; (ii) male versus female; (iii) single versus multiple antibiotic therapy; (iv) cephalosporins versus remaining antibiotic groups. Results: Between January 2002 and December 2009 6378 patients with surgical infection were treated at our level 1 trauma centre, whereas a total of 159 patients (2.5 %) developed during the hospital stay a Clostridium difficile-associated diarrhoea. The incidence of CD-associated infection increased dramatically in 2009 and was more than quadrupled compared with 2002 or 2003. Patients over 65 years of age developed more frequently a CD-associated infection compared to patients less than 65 years of age (OR 1.96, 95 % CI 1.4 to 2.7). There was no difference between males and females as well as between multiple antibiotic therapy and single antibiotic therapy (OR 0.96, 95 % CI 0.7 to 1.3). Cephalosporins were the most often administered antibiotics with a median value of 45.9 % followed by gyrase inhibitors with a median value of 17.2 %. However, there were no differences between antibiotic groups (OR 1.11; 95 % CI 0,87–1,5). Conclusions: In conclusion, CD-associated infections are frequent nascent infections on a septic ward at a level 1 trauma centre. This could result in a therapeutic dilemma in the future, especially in septic surgery, where antibiotic therapy is an essential component of the therapy. Thus, further prospective clinical and experimental studies are essential.

Schlüsselwörter

Clostridium difficile - septische Unfallchirurgie - Inzidenz

Key words

Clostridium difficile - septic trauma surgery - incidence

Literatur

• 1 Bartlett J G. Clostridium difficile: history of its role as an enteric pathogen and the current state of knowledge about the organism.  Clin Infect Dis. 1994;  18 S265-S272
• 2 George W L, Sutter V L, Goldstein E J et al. Aetiology of antimicrobial-agent-associated colitis.  Lancet. 1978;  1 802-803
• 3 Kelly C P, Pothoulakis C, LaMont J T. Clostridium difficile colitis.  N Engl J Med. 1994;  330 257-262
• 4 Larson H E, Price A B, Honour P et al. Clostridium difficile and the aetiology of pseudomembranous colitis.  Lancet. 1978;  1 1063-1066
• 5 Karlstrom O, Fryklund B, Tullus K et al. A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. The Swedish C. difficile Study Group.  Clin Infect Dis. 1998;  26 141-145
• 6 Mylotte J M, Graham R, Kahler L et al. Impact of nosocomial infection on length of stay and functional improvement among patients admitted to an acute rehabilitation unit.  Infect Control Hosp Epidemiol. 2001;  22 83-87
• 7 Kimmey M B, Elmer G W, Surawicz C M et al. Prevention of further recurrences of Clostridium difficile colitis with Saccharomyces boulardii.  Dig Dis Sci. 1990;  35 897-901
• 8 Kyne L, Farrell R J, Kelly C P. Clostridium difficile.  Gastroenterol Clin North Am. 2001;  30 753-777 ix-x
• 9 Brown E, Talbot G H, Axelrod P et al. Risk factors for Clostridium difficile toxin-associated diarrhea.  Infect Control Hosp Epidemiol. 1990;  11 283-290
• 10 McDonald L C, Owings M, Jernigan D B. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003.  Emerg Infect Dis. 2006;  12 409-415
• 11 Vonberg R P, Schwab F, Gastmeier P. Clostridium difficile in discharged inpatients, Germany.  Emerg Infect Dis. 2007;  13 179-180
• 12 Wilcox M H, Cunniffe J G, Trundle C et al. Financial burden of hospital-acquired Clostridium difficile infection.  J Hosp Infect. 1996;  34 23-30
• 13 Vonberg R P, Reichardt C, Behnke M et al. Costs of nosocomial Clostridium difficile-associated diarrhoea.  J Hosp Infect. 2008;  70 15-20