J Korean Neurotraumatol Soc.  2011 Oct;7(2):92-98. 10.13004/jknts.2011.7.2.92.

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

• Kim YS
• Jeon HJ
• Nam SA
• Cho BM
• Park SH
• Oh SM

• KMID: 2019921
• DOI: http://doi.org/10.13004/jknts.2011.7.2.92

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.

Keyword

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

MeSH Terms

Anti-Bacterial Agents
C-Reactive Protein
Clostridium
Colonoscopy
Diarrhea
Enteral Nutrition
Enterocolitis, Pseudomembranous
Humans
Intensive Care Units
Length of Stay
Multivariate Analysis
Neurosurgery
Recurrence
Retrospective Studies
Risk Factors
Serum Albumin
Sigmoidoscopy
Anti-Bacterial Agents
C-Reactive Protein
Serum Albumin

Figure

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  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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