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Clostridium difficile in der Viszeralchirurgie

Clostridium difficile in visceral surgery

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Zusammenfassung

Hintergrund

Für Chirurgen ist es wichtig, sich mit Clostridium-difficile-Infektionen (CDI) auseinanderzusetzten, da die Inzidenz und die Virulenz dieser potenziell lebensbedrohlichen Erkrankung zunehmen.

Fragestellung

Das Ziel der vorliegenden Studie war, zu untersuchen, wie häufig CDI bei chirurgischen Patienten vorkommen, welche Therapiemaßnahmen erfolgreich sind und welche Faktoren für einen tödlichen Verlauf prädisponieren.

Material und Methoden

Es wurde eine retrospektive Kohortenanalyse durchgeführt.

Ergebnisse

Von Januar 2004 bis Juni 2012 lag die Inzidenz im Universitätsklinikum St. Josef Hospital Bochum über alle Fachabteilungen verteilt bei 0,6 % (1669/301.919). Die Inzidenz der CDI in der Viszeralchirurgie lag bei 0,9 % (179/18.864). Im Jahr 2004 gab es in der Viszeralchirurgie einen Patienten mit CDI, 2011 stieg die Gesamtzahl auf 41 an. 84 % (151/179) der viszeralchirurgischen Patienten hatten vor dem Auftreten der CDI eine Antibiotikatherapie erhalten. Zur Therapie der CDI erhielten 75 % (134/179) Metronidazol, 60 % (107/179) erhielten Vancomycin und 44 % (79/179) erhielten eine Kombinationstherapie, Tygecyclin oder Fidaxomidin. Die Gesamtletalität betrug 7 % (12/179). Es bestand eine erhöhte Letalität bei CDI-assoziierter Sepsis, Wiederaufnahme auf die Intensivstation, Katecholamintherapie und Reintubation. Bei 4 % (7/179) erfolgte eine Kolektomie. Nach Kolektomie verstarben trotz intensivmedizinischer Maximaltherapie 86 % (6/7) der Patienten.

Schlussfolgerung

Die meisten viszeralchirurgischen Patienten mit CDI können konservativ behandelt werden, allerdings besteht eine hohe Letalität, wenn aufgrund der CDI eine intensivmedizinische Therapie erforderlich wird. Die Letalität nach Kolektomie beträgt fast 100 %, weil die Operation meistens als Ultima Ratio im Vollbild der Sepsis erfolgt. Hauptrisikofaktor für eine CDI ist eine vorausgegangene Antibiotikatherapie.

Abstract

Background

For surgeons the early identification of patients with clostridium difficile infections (CDI) is important, because the incidence and virulence of this potentially life-threatening disease are increasing.

Objectives

The aim of this study was to describe the frequency of CDI among surgical patients, to analyze which treatment was successful and to define which factors were associated with mortality.

Methods

A retrospective analysis of patients with CDI was performed.

Results

From January 2004 to June 2012 the overall incidence of CDI among all departments at the St. Josef Hospital, Ruhr University Bochum was 0.6 % (1669 out of 301,919 patients). In 2004 the number of surgical patients with CDI was 1 which increased to 41 in 2011. Before the diagnosis of CDI was made 84 % (151 out of 179) of patients had received an antibiotic treatment. Conservative management of CDI was performed with metronidazole in 75 % (134 out of 179), 60 % (107 out of 179) received vancomycin, while 44 % (79 out of 179) received a combination of metronidazole and vancomycin, tygecycline or fidaxomidin. The overall mortality was 7 % (12 out of 179). There was a significant association with mortality for patients with sepsis, readmission to the intensive care unit (ICU), requirement for vasopressor therapy and intubation with mechanical ventilation. In 4 % of patients (7 out of 179) colectomy was carried out. Despite maximum intensive care management, 86 % (6 out of 7) of patients who underwent colectomy ultimately died.

Conclusion

Although conservative management is successful for most patients with CDI, the mortality is high for patients who require intensive care management secondary to CDI. Mortality after colectomy for CDI is almost 100 %, mostly because the operation is usually only performed as a last resort in patients with sepsis. The most important risk factor for CDI is a prior antibiotic therapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Herzog, C. Deleites, O. Belyaev, A.M. Chromik und W. Uhl geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, St. Josef Hospital, Klinikum der Ruhr Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland

    T. Herzog, C. Deleites, O. Belyaev, A.M. Chromik &  W. Uhl

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  1. T. Herzog
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  2. C. Deleites
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  3. O. Belyaev
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  4. A.M. Chromik
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  5. W. Uhl
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Correspondence to W. Uhl.

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Herzog, T., Deleites, C., Belyaev, O. et al. Clostridium difficile in der Viszeralchirurgie. Chirurg 86, 781–786 (2015). https://doi.org/10.1007/s00104-014-2905-9

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