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中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 348 -351. doi: 10.3877/cma.j.issn.1674-1358.2020.04.016

所属专题: 经典病例 经典病例 文献

病例报告

四例肝硬化合并艰难梭菌感染者的诊治及文献复习
洪珊1, 陈旭1, 胡居龙1, 李坪1,()   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院消化内科
  • 收稿日期:2019-10-06 出版日期:2020-08-15
  • 通信作者: 李坪
  • 基金资助:
    首都特色临床应用研究项目(No. Z181100001718084)

Diagnosis and treatment of four liver cirrhosis cases complicated with Clostridium difficile infection and literature review

Shan Hong1, Xu Chen1, Julong Hu1, Ping Li1,()   

  1. 1. Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2019-10-06 Published:2020-08-15
  • Corresponding author: Ping Li
  • About author:
    Corresponding author: Li Ping, Email:
引用本文:

洪珊, 陈旭, 胡居龙, 李坪. 四例肝硬化合并艰难梭菌感染者的诊治及文献复习[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(04): 348-351.

Shan Hong, Xu Chen, Julong Hu, Ping Li. Diagnosis and treatment of four liver cirrhosis cases complicated with Clostridium difficile infection and literature review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(04): 348-351.

目的

探讨肝硬化晚期合并难辨梭菌感染的临床特点和预后。

方法

回顾性分析于首都医科大学附属北京地坛医院2018年1月年至2019年5月单中心诊断的4例肝硬化合并难辨梭菌感染者的诊疗过程及随访,并结合文献复习。

结果

4例患者均为失代偿期肝硬化且合并多种并发症,难辨梭菌感染为首发,通过粪便检测难辨梭菌葡糖脱氢酶(GDH)联合毒素酶联免疫法检测确诊,其中3例为暴发型,1例为复发;4例患者均给予万古霉素治疗;2例存活,2例于发病后1年内死亡且其中1例于确诊24 h内死亡。

结论

提高临床认知、尽早完善确诊实验室检查并及时确诊治疗是控制肝硬化合并难辨梭菌感染的关键。

Objective

To investigate the characteristics and prognosis of Clostridium difficile infection in patients with advance liver cirrhosis.

Methods

From January 2018 to May 2019, four cases were diagnosed with Clostridium difficile infection and liver cirrhosis in Beijing Ditan Hospital, Capital Medical University. The diagnosis, treatment and clinical outcome of the four cases were analyzed, respectively and relevant literature were reviewed.

Results

All cases with initial episode with Clostridium difficile infection were advanced liver cirrhosis patients with various complications. A definite diagnosis was performed by fecal detection of Clostridium difficile gluconate dehydrogenase (GDH) combined with toxin enzyme-linked immunosorbent assay. There were 3 cases with fulminant type and 1 case recurred. All 4 cases were treated with vancomycin. Two cases died within one year after onset, among whom one case died within 24 h.

Conclusions

Improving clinical cognition, perfect diagnosis test, timely diagnosis and treatment of Clostridium difficile in patients with liver cirrhosis was essential to reduce the incidence and morbidity.

[1]
Meyyur Aravamudan V, Khan SR, Hussain I. Clostridium difficile Infection in liver cirrhosis carries a higher risk of mortality: A comprehensive literature review[J]. cureus,2019,11(8):e5463.
[2]
Bartlett JG, Chang TW, Gurwith M, et al. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia[J]. N Engl J Med,1978,298(10):531-534.
[3]
Bartlett JG. Clinical practice. Antibiotic-associated diarrhea[J]. N Engl J Med,2002,346(5):334-339.
[4]
Crobach MJ, Planche T, Eckert C, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection[J]. Clin Microbiol Infect,2016,22(Suppl 4):S63-S81.
[5]
Leffler DA, Lamont JT. Clostridium difficile infection[J]. N Engl J Med,2015,372(16):1539-1548.
[6]
Jin K, Wang S, Huang Z, et al. Clostridium difficile infections in China[J]. J Biomed Res,2010,24(6):411-416.
[7]
徐英春, 张曼. 中国成人艰难梭菌感染诊断和治疗专家共识[J]. 协和医学杂志,2017,8(2):131-138.
[8]
Tang C, Cui L, Xu Y, et al. The incidence and drug resistance of Clostridium difficile infection in Mainland China: a systematic review and meta-analysis[J]. Sci Rep,2016,6:37865.
[9]
Mavros MN, Alexiou VG, Vardakas KZ, et al. Underestimation of Clostridium difficile infection among clinicians: an international survey[J]. Eur J Clin Microbiol Infect Dis,2012,31(9):2439-2444.
[10]
Vanjak D, Girault G, Branger C, et al. Risk factors for Clostridium difficile infection in a hepatology ward[J]. Infect Control Hosp Epidemiol,2017,28(2):202-204.
[11]
Bajaj JS, Ananthakrishnan AN, Hafeezullah M, et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: A national and tertiary center perspective[J]. Am J Gastroenterol, 2010 ,105(1):106-113.
[12]
Pop A, Procopet B, Stefanescu H, et al. Clostridium difficile screening in cirrhosis: one for all, or some for one?[J]. Dig Dis Sci,2015,60(12):3825-3826.
[13]
Asempa TE, Nicolau DP. Clostridium difficile infection in the elderly: an update on management[J]. Clin Interv Aging,2017,12:1799-1809.
[14]
Căruntu FA, Gheorghiță V. Clostridium difficile infection in hospitalized cirrhotic patients with hepatic encephalopathy[J]. J Gastrointestin Liver Dis,2016,25(1):120-121.
[15]
Yan D, Huang YD, Chen YB, et al. Risk factors for Clostridium difficile infection in cirrhotic patients[J]. Hepatobiliary Pancreat Dis Int,2019,;18(3):237-241.
[16]
Garcia-Tsao G, Lim JK. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program[J]. Am J Gastroenterol, 2019,104(7):1802-1829.
[17]
Brown MR, Jones G, Nash KL, et al. Antibiotic prophylaxis in variceal hemorrhage: timing, effective-ness and Clostridium difficile rates[J]. World J Gastroenterol,2010,16(42): 5317-5323.
[18]
Dultz G, Piiper A, Zeuzem S, et al. Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis[J]. Aliment Pharmacol Ther,2015,41(5):459-466.
[19]
Smith EZ, Northup PG, Argo CK. Predictors of mortality in cirrhosis inpatients with Clostridium difficile infection[J]. J Clin Gastroenterol, 2018,52(8):747-751.
[20]
庞君丽, 崔恩博, 曲芬. 肝硬化消化道出血合并艰难梭菌感染1例[J]. 传染病信息,2015,28(4):244-245.
[21]
Saha S, Khanna S. Management of Clostridioides difficile colitis: insights for the gastroenterologist[J]. Therap Adv Gastroenterol,2019;12:1-15.
[22]
Olmedo M, Reigadas E, Valerio M, et al. Is it reasonable to perform fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with liver cirrhosis?[J]. Rev Esp Quimioter,2019,32(2):205-207.
[23]
Bajaj JS, Ananthakrishnan AN, Hafeezullah M, et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: a national and tertiary center perspective[J]. Am J Gastroenterol, 2010,105(1):106-113.
[24]
Smith EZ, Northup PG, Argo CK. Predictors of mortality in cirrhosis inpatients with Clostridium difficile infection[J]. J Clin Gastroenterol,2018,52(8):747-751.
[25]
Hong SJ, Feuerstadt P, Brandt LJ. MELD is the only predictor of short-term mortality in cirrhotic patients with C. difficile infection[J]. Dig Liver Dis,2019,51(2):275-280.
[26]
Kruger AJ, Durkin C, Mumtaz K, et al. Early readmission predicts increased mortality in cirrhosis patients after Clostridium difficile infection[J]. J Clin Gastroenterol,2019,53(8):e322-e327.,
[27]
Fehér C, Mensa J. A comparison of current guidelines of five international societies on Clostridium difficile infection management[J]. Infect Dis Ther,2016,5(3):207-230.
[28]
Saab S, Alper T, Sernas E, et al. Hospitalized patients with cirrhosis should be screened for Clostridium difficile colitis[J]. Dig Dis Sci,2015,60(10):3124-3129.
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