Clinical Characteristics And Risk Factors Of Clostridium Difficile Enteritis

Objective: To study the clinical characteristics,risk factors of Clostridium difficile enteritis(CDE)and to provide clinical reference for its prevention and treatment.Methods: The clinical data of 33 patients with CDE admitted in the First Affiliated Hospital,Jinan University from January 2014 to December 2021 were collected,and 69 patients with irritable bowel syndrome(IBS)were selected as the control group.Univariate analysis,multivariate Logistic analysis and receiver operating characteristic(ROC)curve were used to explore the clinical characteristics and risk factors of CDE.Results:(1)This study included in 33 patients with CDE,the average age of the patients was(51.22±26.77)years,the male to female ratio was 1.06:1.(2)The most common symptoms of CDE were diarrhea(84.8%),followed by abdominal pain(48.5%),hematochezia / black stool(39.4%),fever(24.2%),nausea / vomiting(18.2%),weight loss(15.2%),acute weight(12.1%)and abdominal distension(9.1%),compared with IBS group.There were significant differences in abdominal pain,diarrhea,acute weight,fever,hematochezia and abdominal distension in CDE group.(3)The white blood cell count increased in 10 patients with CDE and the percentage of neutrophils in 14 patients with CDE.The proportion of increased white blood cell count and neutrophil percentage in CDE patients was higher than that in IBS group.Hypersensitive C-reactive protein increased in 28 cases(84.8%),erythrocyte sedimentation rate increased in 9 cases(27.3%),and procalcitonin increased in 24cases(72.7%).The elevated proportion of hypersensitive C-reactive protein,erythrocyte sedimentation rate and procalcitonin in CDE patients was higher than that in IBS group.8 patients with CDE had hypokalemia,and the proportion of hypokalemia in CDE patients was higher than that in IBS group.The average albumin of CDE patients was(44 ±4.64)g,which was lower than that of IBS group(P < 0.01).Albumin decreased in 15 patients with CDE,and the amount of albumin decreased in CDE patients was higher than that in IBS group(P < 0.01).30 patients with CDE had positive fecal occult blood,and the number of positive fecal occult blood in CDE patients was higher than that in IBS group(P < 0.01).(4)Abdominal CT showed thickening and edema of intestinal wall in 8 patients with CDE.Abdominal CT showed abdominal / pelvic effusion in 2 patients with CDE.The most common colonoscopic manifestations of CDE were hyperemia and edema(84.8%)and erosion(27.3%),followed by ulcers(18.2%),erythema(15.2%),roughness(3.0%),pseudomembrane(6.0%),leukoplakia(0%),stenosis or deformation(0%).(5)Univariate analysis showed that the number of patients with age ≥ 65 years old in CDE group(33.3%)was higher than that in IBS group(13.0%).The number of patients with chronic underlying diseases in CDE group(54.5%)was higher than that in IBS group(15.9%).The number of patients who used chemotherapeutic drugs in CDE group(9.1%)was higher than that in IBS group(0%).The number of patients using proton pump inhibitors in the CDE group(57.6%)was higher than that in the IBS group(10.1%).The number of patients with hospital stay ≥ 10 days in the CDE group(78.8%)was higher than that in the IBS group(10.1%).The number of patients who used β-lactam antibiotics in CDE group(57.6%)was higher than that in IBS group(23.2%).The number of patients with inflammatory bowel disease in the CDE group(27.3%)was higher than that in the IBS group(0%).(6)Hospital stay ≥ 10 days and the use of proton pump inhibitors were independent risk factors for CDE.Conclusion:(1)CDE is common in elderly males.(2)Clinical symptoms of diarrhea occurred in patients close to 85%CDE,and others such as abdominal pain,acute postnatal weight,fever,hematochezia / black stool and abdominal distension were also common.In laboratory examination,elevated peripheral blood leukocyte count,neutrophil percentage,hypersensitive C-reactive protein,erythrocyte sedimentation rate,procalcitonin,hypokalemia,hypoproteinemia and positive fecal occult blood were common manifestations of CDE.(3)Age ≥ 65 years old,chronic underlying diseases,use of proton pump inhibitors,use of chemotherapeutic drugs,days of hospitalization ≥ 10 days,use of β-lactam antibiotics and inflammatory bowel disease were risk factors for CDE,and days of hospitalization ≥ 10 days and use of proton pump inhibitors were independent risk factors for CDE.