N. Almeida1, N. Silva2, F. Parente2, F. Portela1, H. Gouveia1, B. Alexandrino2, J. Alves Moura2, D. Freitas1.
Resumo
Introdução: A colite pseudomembranosa (CPM) é uma doença infecciosa que surge geralmente na sequência de antibioterapia prévia.
Objectivos: Caracterizar os doentes com CPM em dois Serviços de um Hospital Central.
Material e Métodos: Consideraram-se os doentes internados num Serviço de Medicina (SM) e num de Gastrenterologia (SGE) com diagnóstico principal ou secundário de CPM, entre Janeiro/1995 e Julho/2003, registando-se a idade, sexo, clínica, antibióticos (AB) e outros factores de risco, processo de diagnóstico, complicações e tratamento.
Resultados: considerámos 80 doentes (43-SGE; 37-SM); média etária - 68,6 ± 17,7 anos; texo masculino - 52,5%; Antibioterapia nos 3 meses prévios - 85%; tempo médio de AB 10,5 ± 6,1 dias. AB mais implicados: cefalosporinas, amoxicilina/ácido clavulânico e quinolonas.
Factores de Risco Associados: insuficiência renal (22,5%), insuficiência cardíaca (22,5%); doente previamente acamado (36,3%).
Métodos de Diagnóstico: pesquisa de toxina-58 doentes (em 36); colonoscopia - 62 (em 53); cultura - 23 (em 16). A mortalidade foi de 18,8% (n=15); recorrências - 10% (n=8).
]]> Terapêutica: metronidazol - 37 doentes (46,3%); vancomicina - 24 (30%); metronidazol + vancomicina - 12 (15%).Diferenças entre Serviços: média etária (SM - 72,9 e SGE - 64,9); motivo de internamento (SGE - distúrbios intestinais, SM - infecção respiratória); métodos de diagnóstico (colonoscopia mais no SGE); terapêutica (SM - metronidazol; SGE - vancomicina e metronidazol + vancomicina).
Conclusões: A CPM atinge doentes mais idosos que geralmente foram submetidos a antibioterapia prévia, sobretudo com ß-lactâmicos. Considerados dois Serviços verificam-se diferenças quanto à faixa etária, co-morbilidades e factores de risco, implicando assim opções diagnósticas e terapêuticas distintas.
Summary
Introduction: pseudomembranous colitis (PMC) is an infectious disease that generally begins after antibiotic treatment.
Objectives: Characterize the patients with PMC in two Services of a
Material and Methods: we considered the patients admitted in a Medicine (MS) and in a Gastroenterology (GES) Service with primary or secondary diagnosis of PMC, between January/1995 and July/2003 and registered the age, gender, clinical presentation, antibiotics (AB) and other risk factors, diagnostic procedures, complications and treatment.
Results: we considered 80 patients (43 - GES and 37 - MS); Mean age - 68,6 ± 17,7 years; 52,5% were male; Antibiotic treatment in the previous 3 months - 85%; Mean time of antibiotic treatment - 10,5 ± 6,1 days. Most Commonly Involved Antibiotics: cephalosporins, amoxicillin/clavulanic acid and quinolones. Associated risk factors: renal insufficiency (22,5%); cardiac insufficiency (22,5%); previously dependent patient ( 36,3%).
]]> Diagnostic procedures: toxin search-58 patients ( in 36 ), colonoscopy - 62 ( in 53); culture - 23 (in 17 ). The mortality rate was 18,8% (n = 15); recurrence rate - 10% (n = 8).Therapeutics: metronidazol - 37 patients (46,3%); vancomycin - 24 (30%); metronidazol + vancomycin – 12 (15%).
Differences Between Services: mean age (MS - 72,9 and GES - 64,9); admission criteria (GES - intestinal disorders, MS – respiratory infections); diagnostic procedures (colonoscopy more frequent in GES); therapeutic options (MS - metronidazol; GES - vancomycin and metronidazol + vancomycin).
Conclusions: PMC is more common in older patients that were generally submitted to previous antibiotic treatment, especially with ß-lactamics. Considering two distinct Services we observed differences concerning age, co-morbility and risk factors that implied distinct diagnostic and therapeutic approaches.
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]]> (1) Serviço de Gastrenterologia dos Hospitais da Universidade de Coimbra, Coimbra, Portugal.
(2) Serviço de Medicina II dos Hospitais da Universidade de Coimbra, Coimbra, Portugal.
* Trabalho apresentado no XXIV Congresso Nacional de Gastrenterologia e Endoscopia Digestiva.
Recebido para publicação: 23/03/2005
Aceite para publicação: 09/09/2005
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