Metronidazole may inhibit intestinal colonization with Clostlidium difficile

被引:20
作者
Cleary, RK [1 ]
Grossmann, R [1 ]
Fernandez, FB [1 ]
Stull, TS [1 ]
Fowler, JJ [1 ]
Walters, MR [1 ]
Lampman, RM [1 ]
机构
[1] St Joseph Mercy Hosp, Dept Surg, Ann Arbor, MI 48106 USA
关键词
antibiotic-associated colitis; pseudomembranous colitis; C-difficile colitis; antibiotic-associated diarrhea;
D O I
10.1007/BF02235760
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: Antibiotics suppress normal gut flora, allowing overgrowth of acquired or native Clostridium difficile, with release of toxins that cause mucosal inflammation. Oral metronidazole is used to treat antibiotic-associated colitis (pseudomembranous colitis). This study was designed to determine whether oral metronidazole, as part of preoperative bowel preparation, prevents or decreases incidence of antibiotic-associated colitis after elective colonic and rectal procedures. METHODS: Eighty-two patients (40 men) were prospectively, randomly assigned to receive one of two oral antibiotic regimens before colorectal surgery. Ail patients underwent mechanical bowel preparation with polyethylene glycol-electrolyte lavage solution before administration of oral antibiotics. Group 1 (n = 42) patients received three doses (1 g/dose) of neomycin and erythromycin. Group 2 (n = 40) patients received three doses (1 g/dose) of neomycin and metronidazole. Both groups received one preoperative and three postoperative doses of intravenous cefotetan (2 g/dose). Both groups had stool samples tested for C. difficile toxin in the preoperative and postoperative periods by enzyme-linked immunoabsorbent assay or by tissue culture cytotoxicity. Patients with preoperative stool studies positive for C. difficile were excluded from the study. RESULTS: Treatment groups were not different for age, gender, or surgical procedure. Mean age +/- 1 standard deviation was 67.6 +/- 13.6 (range, 34-34) years in Group 1 and 62.1 +/- 13.5 (range, 35-84) years in Group 2 (P = 0.069). Mean length of hospital stay +/- 1 standard deviation was 9.76 +/- 4.9 (range, 4-28) days for Group 1 and 8.05 +/- 2.6 (range, 3-14) days for Group 2 (P = 0.053). Five patients in Group 1 (neomycin and erythromycin) and one patient in Group 2 (neomycin and metronidazole) had positive stool studies for C. difficile. Relative risk of colonization with C. difficile in Group 1 was 4.76 times that in Group 2 (95 percent confidence interval, 0.581, 33). This difference was not statistically significant (P = 0.202). There were no significant differences in C. difficile colonization rates with respect to age, length of stay, or gender. CONCLUSIONS: This study suggests that there may be a clinical association between use of metronidazole preoperatively and inhibition of intestinal colonization by C. difficile in this patient population undergoing colonic and rectal surgery.
引用
收藏
页码:464 / 467
页数:4
相关论文
共 20 条
[1]   STAPHYLOCOCCAL ENTEROCOLITIS FOLLOWING ANTIBIOTIC THERAPY [J].
ALTEMEIER, WA ;
HILL, EO ;
HUMMEL, RP .
ANNALS OF SURGERY, 1963, 157 (06) :847-&
[2]  
[Anonymous], 1893, Bull Johns Hopkins Hosp
[3]   ANTIBIOTIC-ASSOCIATED PSEUDOMEMBRANOUS COLITIS DUE TO TOXIN-PRODUCING CLOSTRIDIA [J].
BARTLETT, JG ;
CHANG, TW ;
GURWITH, M ;
GORBACH, SL ;
ONDERDONK, AB .
NEW ENGLAND JOURNAL OF MEDICINE, 1978, 298 (10) :531-534
[4]   DIAGNOSIS AND TREATMENT OF CLOSTRIDIUM-DIFFICILE COLITIS [J].
FEKETY, R ;
SHAH, AB .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 269 (01) :71-75
[5]   CLOSTRIDIUM-DIFFICILE DIARRHEA AND COLONIZATION AFTER TREATMENT WITH ABDOMINAL INFECTION REGIMENS CONTAINING CLINDAMYCIN OR METRONIDAZOLE [J].
GERDING, DN ;
OLSON, MM ;
JOHNSON, S ;
PETERSON, LR ;
LEE, JT .
AMERICAN JOURNAL OF SURGERY, 1990, 159 (02) :212-217
[6]  
HOLMES NJ, 1996, CURR SURG, V53, P16
[7]   CLOSTRIDIUM-DIFFICILE COLITIS - AN INCREASING HOSPITAL-ACQUIRED ILLNESS [J].
JOBE, BA ;
GRASLEY, A ;
DEVENEY, KE ;
DEVENEY, CW ;
SHEPPARD, BC .
AMERICAN JOURNAL OF SURGERY, 1995, 169 (05) :480-483
[8]   CLOSTRIDIUM-DIFFICILE COLITIS [J].
KELLY, CP ;
POTHOULAKIS, C ;
LAMONT, JT .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 330 (04) :257-262
[9]  
LIPSETT PA, 1994, SURGERY, V116, P491
[10]  
MARR JJ, 1975, GASTROENTEROLOGY, V69, P352