Analysis of Clinical Characteristics and Risk Factors to Neurosurgical Patients with Clostridium Difficile-Associated Diarrhea

Yong-Sang Kim; Hong-Jun Jeon; Su-A Nam; Byung Moon Cho; Se-Hyuck Park; Se Moon Oh

doi:10.13004/jknts.2011.7.2.92

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

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Kim, Jeon, Nam, Cho, Park, and Oh: Analysis of Clinical Characteristics and Risk Factors to Neurosurgical Patients with Clostridium Difficile-Associated Diarrhea

Clinical Article

Journal of Korean Neurotraumatology Society 2011; 7(2): 92-98.

Published online: 31 October 2011

DOI: https://doi.org/10.13004/jknts.2011.7.2.92

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, 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, nschbm@hanmail.net

Received 22 August 2011 Revised 15 September 2011 Accepted 15 September 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 and Tables

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.

FIGURE 2

Clinical response of Clostridium difficile-associated colitis (CDAD) to use antibiotics.

TABLE 1

Comparisons of clinical characteristics between neurologically impaired and well active group

^*continuous variable calculated by using Student-t test and categorical variable by using chi-square test. GCS: Glasgow Coma Scale, ICU: intensive care unit, CDAD: Clostridium difficile-associated diarrhea

TABLE 2

Comparisons of laboratory data between neurologically impaired and well active group

^*p value: continuous variable calculated by using Student-t test and categorical variable by using chi-square test. GCS: Glasgow Coma Scale, CRP: C-reactive protein

TABLE 3

Use of antibiotics between neurologically impaired and well active group

^*chi-square test. ns: non-specific, GCS: Glasgow Coma Scale, 1st: 1st cephalosporin, 2nd: 2nd cephalosporin, 3rd: 3rd cephalosporin, 4th: 4th cephalosporin

TABLE 4

Univariate analysis of risk factors for pseudomembranous colitis among the Clostridium difficile-associated diarrhea

^*continuous variable calculated by using Student-t test and categorical variable by using chi-square test. ICU: intensive care unit, PMC: pseudomembranous colitis

TABLE 5

Multivariate regression analysis of risk factors for pseudomembranous colitis among the Clostridium difficile-associated diarrhea

^*multivariate analyses were performed by using a binary logistic regression. ICU: intensive care unit

Notes

The authors have no financial conflicts of interest.

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