위장관계수술 후 발생한 위막성 대장염

박병수; 김재훈; 서형일; 김현성; 김대환; 조홍재; 전태용; 김동헌; 심문섭; 김석; 강형숙

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자료유형: 학술저널

저자정보: 박병수 (부산대학교) 김재훈 (부산대학교) 서형일 (부산대학교) 김현성 (부산대학교) 김대환 (부산대학교) 조홍재 (부산대학교) 전태용 (부산대학교) 김동헌 (부산대학교) 심문섭 (부산대학교) 김석 (부산대학교) 강형숙 (동아대학교)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research 대한외과학회지 Vol.77 No.2

발행연도: 2009.8

수록면: 106 - 112 (7page)

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Purpose: The risk factors of pseudomembranous colitis (PMC) are well known. However, there have been no studies of PMC after gastrointestinal operation. The aim of this study was to evaluate the risk factors and to establish the guiding principles for PMC after gastrointestinal operation.
Methods: We performed a retrospective study of 39 PMC patients after gastrointestinal operation from January 2004 to December 2008. A control group of one hundred and seventeen matched to a PMC group by date of operation was chosen in a random fashion. Preoperative, operative, and postoperative factors of PMC were evaluated.
Results: The incidence of PMC after gastrointestinal operation was 0.63%. On univariate analysis, among preoperative factors, albumin, PT-INR and neutropenia were significant risk factors for PMC. There was no difference in the operative factors. Among postoperative factors, duration of cephalosporin, aminoglycoside, H₂ blocker administration were significant risk factors for PMC after gastrointestinal operation. And transfusion, duration of NPO, length of stay in intensive care unit (ICU) and postoperative intraabddominal abscess, pneumonia were also significant risk factors. On multivariate analysis, the independent risk factors for PMC after gastrointestinal operation were duration of aminoglycoside administration, transfusion volume and length of stay in ICU. When period of study was divided by three months, incidence of PMC at a specific period was high. After limiting of prophylactic antibiotics, incidence of PMC fell to 0.36%.
Conclusion: To prevent PMC after gastrointestinal operation, we need sustained efforts to establish stricter guidelines about prophylactic antibiotics and transfusion, and to minimize length of stay in ICU.

#Pseudomembranous colitis #Gastrointestinal operation #위막성 대장염 #위장관계 수술

참고문헌 (21)

참고문헌 신청

1. [학술지(정기간행물)] - Crabtree T / 2007 / Clostridium difficile in cardiac surgery: risk factors and impact on postoperative outcome / Ann Thorac Surg 83 : 1396 ~ 1402

2. [학술지(정기간행물)] - Greenstein AJ / 2008 / Risk factors for the development of fulminant Clostridium difficile colitis / Surgery 143 : 623 ~ 629

3. [학술지(정기간행물)] - Lee KS / 2006 / Who are susceptible to pseudomembranous colitis among patients with presumed antibiotic-associated diarrhea? / Dis Colon Rectum 49 : 1552 ~ 1558

4. [학술지(정기간행물)] - Kyne L / 2002 / Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea / Infect Control Hosp Epidemiol 23 : 653 ~ 659

5. [학술지(정기간행물)] - Aslam S / 2005 / Treatment of Clostridium difficile-associated disease: old therapies and new strategies / Lancet Infect Dis 5 : 549 ~ 557

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