Journal List > J Korean Neurotraumatol Soc > v.7(2) > 1084107

J Korean Neurotraumatol Soc. 2011 Oct;7(2):92-98. Korean.
Published online October 31, 2011.  https://doi.org/10.13004/jknts.2011.7.2.92
Copyright © 2011 Korean Neurotraumatology Society
Analysis of Clinical Characteristics and Risk Factors to Neurosurgical Patients with Clostridium Difficile-Associated Diarrhea
Yong-Sang Kim, MD, Hong-Jun Jeon, MD, Su-A Nam, SN, Byung Moon Cho, MD, Se-Hyuck Park, MD and Se Moon Oh, MD
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Address for correspondence: Byung Moon Cho, MD. Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongnae-gil, Gangdong-gu, Seoul 134-701, Korea. Tel: +82-2-2224-2236, Fax: +82-2-473-7387, Email: nschbm@hanmail.net
Received August 22, 2011; Revised September 15, 2011; Accepted September 15, 2011.

Abstract

Objective

The risk factors of Clostridium difficile-associated diarrhea (CDAD) are well known in medical part. However, there have been a few studies of CDAD about neurosurgical patients. The aim of this study was to investigate clinical characteristics and risk factors of neurosurgical patients with CDAD.

Methods

We retrospectively reviewed the record of eighty-five patients with CDAD between January 2007 and December 2010. They made a diagnosis that used a toxin assay, stool culture and sigmoidoscopy or colonoscopy. We analyzed the association factor such as age, gender, operation, enteral feeding, length of Intensive Care Unit stay, prophylactic antibiotics, duration and number of antibiotics, types of antibiotics, diarrhea onset time, toxin assay, serum albumin, C-reactive protein, pseudomembranous colitis, recurrence rates between the neurologically impaired group and well-active group.

Results

Of 15 parameters, 6 parameters were significantly associated with neurologically impaired group in univariate analysis. The enteral feeding and bed ridden state (p<0.001) frequently had practiced and the intensive care unit stay had longer (p=0.001) and the diarrhea onset time (p=0.034) from the last antibiotics use administered prior to development of the CDAD was lesser. The pseudomembranous colitis and CDAD recurrence had more appeared in impaired group (p<0.001). On multivariate analysis, longer intensive care unit stay (p=0.024) and increasing cumulative days of antibiotic administration (p=0.007) correlated with pseudomembranous colitis.

Conclusion

The data suggest that it may make a vulnerable influence to development of the CDAD in neurologically impaired patients. To prevent the CDAD, we need to practice stricter guidelines about antibiotic usage and minimize length of stay in ICU.

Keywords: Clostridium difficile-associated diarrhea; Antibiotics; Pseudomembranous colitis; Neurosurgery

Figures


FIGURE 1
Descending colon covered with yellowish pseudo-membrane on sigmoidoscopy (A) and CT scan of the abdomen (B) showing gross thickening of the large bowel wall and obliteration of the lumen.
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FIGURE 2
Clinical response of Clostridium difficile-associated colitis (CDAD) to use antibiotics.
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Tables


TABLE 1
Comparisons of clinical characteristics between neurologically impaired and well active group
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TABLE 2
Comparisons of laboratory data between neurologically impaired and well active group
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TABLE 3
Use of antibiotics between neurologically impaired and well active group
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TABLE 4
Univariate analysis of risk factors for pseudomembranous colitis among the Clostridium difficile-associated diarrhea
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TABLE 5
Multivariate regression analysis of risk factors for pseudomembranous colitis among the Clostridium difficile-associated diarrhea
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Notes

The authors have no financial conflicts of interest.

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