| Sažetak | Cilj istraživanja:
Odrediti nakon kojeg antibiotika se najčešće pojavljuje postantibiotski proljev uzrokovan C. difficile te povezanost dobi i spola sa pojavom postantibiotskog proljeva. Također odrediti nakon kojeg antibiotika se najčešće pojavljuju recidivi, koliko traju recidivi te koji su komorbiditeti povezani s recidivima postantibiotskog proljeva u bolesnika liječenih u Klinici za infektologiju KBC Split u razdoblju od 2007. – 2014. godine.
Ustroj istraživanja:
Restrospektivno istraživanje.
Mjesto istraživanja:
Klinika za infektologiju KBC Split.
Sudionici istraživanja:
U istraživanje je uključeno 55 bolesnika liječenih zbog postantibiotskog proljeva uzrokovanog C. difficile u Klinici za infektologiju KBC Split u razdoblu od 2007. do 2014. godine. Kriterij uklučenja je bila otpusna dijagnoza postantibiotskog proljeva uzrokovanog C. difficile. Podaci su prikupljeni iz povijesti bolesti ispitanika.
Glavne mjere ishoda:
Povezanost uzročnika infekcije sa spolom, dobi i komorbiditetom. Povezanost upotrebe antibiotika s postantibiotskim proljevom uzrokovanim C. difficile i recidivom postantibiotskog proljeva, te trajanje recidiva.
Rezultati:
Žene su 1,39 puta češće bolnički liječene zbog postantibiotskog proljeva uzrokovanog C. difficile od muškaraca. Medijan životne dobi oboljelih iznosi 72 god. Najveći broj oboljelih nalazio se u dobnoj skupini starijoj od 65 god. (65%). Utvrdili smo da nema statistički značajne razlike između obilježja spola prema dobnoj kategoriji (p=0,184). Od ukupnog broja oboljelih (55), njih 25% je razvilo recidiv postantibiotskog proljeva. Muškarci su 1,39 puta češće razvijali recidiv. Medijan životne dobi oboljelih od recidiva iznosi 78 god., a najveći broj oboljelih se očekivano nalazio u dobnoj skupini starijoj od 65 god. U 64% bolesnika se recidiv javio samo jedan put, a u 50% slučajeva recidivi su u prosjeku trajali između 30 i 45 dana. Utvrdili smo da nema statistički značajne razlike u odnosu nastanka recidiva bolesti između muškaraca i žena (p=0,472), kao ni recidiva između liječenih muškaraca i žena prema dobnoj kategoriji (p=0,599) i recidiva prema dobnim kategorijama (p=0,204).
Bolesnici koji su uzimali lijek iz skupine cefalosporina (52%) su češće razvijali postantibiotski proljev nego iz drugih skupina antibiotika. Poslije cefalosporina bili su aminopenicilini (26%) te fluorokinoloni (16%).
Recidivi postantibiotskog proljeva su se razvijali češće u bolesnika koji su uzimali antibiotike iz skupine cefalosporina (57%), potom iz skupine fluorokinolona (14%) te aminopenicilina (7%). Najduže trajanje postantibiotskog proljeva je nakon upotrebe cefalosporina (32 dana). Recidivi postantibiotskog proljeva najduže traju kod upotrebe fluorokinolona (42 dana). Utvrdili smo da nema statistički značajne razlike recidiva po antibiotiku (p=0,075).
U terapiji svih oboljelih je najviše korišten metronidazol (80%), a kod terapije recidiva je podjednako često korišten sam metronidazol kao i kombinacija metronidazola i vankomicina (43%).
Najčešći komorbiditet u Klinici za infektologiju KBC Split u razdoblju od 2007. – 2014. god. su očekivano bile kardiovaskularne bolesti (50%). Pola oboljelih je kao dodatni faktor rizika imalo prethodnu hospitalizaciju (<90 dana). Veći broj oboljelih muškaraca (65,21%) je bio prethodno hospitaliziran nego žena (40%). Prethodno je hospitalizirano 60% bolesnika između 41-65 god. i 61% bolesnika starijih od 65 god. Medijan životne dobi svih prethodno hospitaliziranih je 75 god. Od postantibiotskog proljeva je umrlo 7% bolesnika.
Zaključci:
Na učestalost postantibiotskog proljeva uzrokovanog C. difficile utječu starija životna dob (>65 god.) i spol (1,39 puta češće oboljevaju žene).
Na recidive postantibiotskog proljeva također utječe starija životna dob (>65 god.) i spol (1,39 puta češće obole muškarci).
Učestalost postantibiotskog proljeva je češća kod upotrebe antibiotka širkog spektra.
Bolest se češće javlja nakon upotrebe cefalosporina, potom aminopenicilina i fluorokinolona u odnosu na druge antibiotike.
Recidivi postantibiotskog proljeva se češće javljaju nakon upotrebe cefalosporina, potom fluorokinolona pa aminopenicilina. Recidivi bolesti u prosjeku traju između 30 i 45 dana (u 50% slučajeva). Najčešći komorbiditeti su kardiovaskularni (51%).
U terapiji postantibiotskog proljeva u KBC Split u razdoblju od 2007. – 2014. god. se najviše koristi sam metronidazol ili u kombinaciji s vankomicinom. |
| Sažetak (engleski) | Objective:
To determine which antibiotic causes the postantibiotic diarrhea caused by C. difficile most frequently, the relationship between age and gender and the occurence of the postantibiotic diarrhea. To determine which antibiotic is most frequently followed by relapses, the length of duration of the relapses, and what the comorbidity linked to the relapse of the postantibiotic diarrhea is in patients at the Department of Infectious Disease, Clinical Hospital Split in the period from 2007 until 2014.
Design:
This study is retrospecitve.
Settings:
Depratment of Infectious Disease, Clinical Hospital Split.
Participants:
The reserach includes 55 patients with postantibiotic diarrhea caused by C. difficile at the Infectious Disease, Clinical Hospital Split in the period from 2007 until 2014. The criterion for inclusion was the discharge diagnosis of postantibiotic diarrhea caused by C. difficile. The data was collected from the patients' medical history.
Main outcome measures:
The relationship of the cause of the infection with gender, age and comorbidity. The relationship between the usage of antibiotics and the postantibiotic diarrhea caused by C. difficile and the relapse of the postantibiotic diarrhea, as well as the duration of the relapse.
Results:
Women are 1,39 times more often treated for postantibiotic diarrhea caused by C. difficile than men. The age median of the patients is 72 years. The largest number of patients was in the >65 age group (65%). We determined that there are no statistically significant differences between the genders within the age category (p=0,184). Of all the patients considered (55), 25% had developed the relapse of the postantibiotic diarrhea. Men develop the relapse 1,39 times more often than women. The age median of patients with relapse is 78, and the majority of patients with relapse were, as expected, in the >65 age group. In 64% of the patients the relapse appeared just once, and in 50% of the cases the relapses lasted between 30 and 45 days. We determined that there are no statistically important differences in the occurence of relapses between men and women (p=0,472), as well as the relapses of the treated men and women according to age group (p=0,599) and the relapses according to age groups (p=0,204).
The patients who were taking drugs from the cephalosporin group (52%) developed the postantibiotic diarrhea more often than other groups of antibiotics. The cephalosporin was followed by aminopenicillin (26%) and fluoroquinolone (16%).
The relapses of the postantibiotic diarrhea developed more more frequently in patients who were taking the antibiotics from the cephalosporin group (57%), followed by the fluorochinolon group (14%) and aminopenicillin (7%). The longest duration of the postantibiotic diarrhea is after the use of cephalosporin (32 days). The relapses of the postantibiotic diarrhea last the longest with the use od fluorochinolon (42 days). We determined that there were no statistically significant differences of the relapses by antibiotic (p=0,075).
In treatment of all the patients metronizadol was the most frequently used drug (80%), and in treatment of the patients with relapse metronidazol was used as often as the combination of metronidazol and vancomycin (43%).
The highest comorbidities at the Infectious Disease, Clinical Hospital Split in the period from 2007 until 2014 were, as expected, coronary diseases (50%). Half the patients had previous hospitalization as an additional risk factor (<90 days). A higher number of male patients (65,21%) were previously hospitalized than female patients (40%). 60% of patients between the ages of 41 and 65 had been previously hospitalized, and 61% of patients age >65. The median age of all previously hospitalized patients is 75. From the postantibiotic diarrhea died 7% of the patients.
Conclusion:
The frequency of the postantibiotic diarrhea caused by C. difficile is influenced by older age (>65) and gender (women develop it 1,39 times more often than men).
The relapses of the postantibiotic diarrhea are also influenced by older age (>65) and gender (men develop it 1,39 times more frequently).
The frequency of the postantibiotic diarrhea is higher with the use of broad-spectrum antibiotics.
The disease appears more frequently with use of cephalosporin, followed by aminopenicillin and fluorochinolon, than with use of other antibiotics.
The relapses of the postantibiotic diarrhea appear more frequently after using cephalosporin, followed by fluorochinolon and aminopenicillin. The relapses of the disease last on average between 30 and 45 days (in 50% of the cases). The most common comorbidities are cardiovascular (51%).
In treatment of the postantibiotic diarrhea at the Infectious Disease, Clinical Hospital Split in the period from 2007 until 2014 the most frequently used drugs are metronidazol on its own, or in combination with vancomycin. |
