A cluster of fulminant Clostridium difficile colitis in an intensive care unit in Italy

被引:10
作者
Guastalegname, M. [1 ]
Grieco, S. [2 ]
Giuliano, S. [1 ]
Falcone, M. [1 ]
Caccese, R. [3 ]
Carfagna, P. [3 ]
D'ambrosio, M. [3 ]
Taliani, G. [2 ]
Venditti, M. [1 ]
机构
[1] Univ Roma La Sapienza, Policlin Umberto I, Dept Publ Hlth & Infect Dis, I-00161 Rome, Italy
[2] Univ Roma La Sapienza, Policlin Umberto I, Dept Clin Med, I-00161 Rome, Italy
[3] San Giovanni Hosp, Intens Care Unit, Rome, Italy
关键词
Clostridium difficile; Ribotype; 027; Intensive care unit; Septic shock; Fulminant colitis; Epidemic; INFECTION; COLECTOMY; DISEASE; STRAIN; OUTBREAK;
D O I
10.1007/s15010-014-0597-1
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
We describe, for the first time, a cluster of lethal fulminant health-care associated Clostridium difficile (CD) colitis in Italy, observed in the intensive care unit (ICU) of an Italian tertiary care hospital in Rome. For all cases the cause of ICU admission was CD-related septic shock. Three out of seven patients were residents in a long-term care facility in Rome, and the others had been transferred to the ICU from different medical wards of the same hospital. Five patients died within 96 h of ICU admission. Because of a clinical deterioration after 4 days of adequate antibiotic therapy, two patients underwent subtotal colectomy: both of them died within 30 days of surgical intervention. In four cases, ribotyping assay was performed and ribotype 027 was recognized. This high mortality rate could be attributable to three findings: the extent of disease severity induced by the strain 027, the delay in antimicrobial therapy administration, and the lack of efficacy of the standard antibiotic treatment for fulminant CD colitis compared to an earlier surgical approach. In order to contain a CD infection epidemic, control and surveillance measures should be implemented, and empirical therapy should be administered. Because of potential 027 ribotype CD spread in Italy, CDI should be regarded with a high index of suspicion in all patients presenting with shock and signs or symptoms suggesting abdominal disease, and an early surgical approach should be considered.
引用
收藏
页码:585 / 589
页数:5
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