Brar H S, Surawicz C M
Harborview Medical Center, Seattle, WA 98104, USA.
Can J Gastroenterol. 2000 Jan;14(1):51-6. doi: 10.1155/2000/324025.
Clostridium difficile is the most common nosocomial infection of the gastrointestinal tract. Most cases are associated with antibiotic therapy that alters the fecal flora, allowing overgrowth of C difficile with production of its toxins. Diagnosis is made by detection of the organism or toxin in the stools. A variety of different tests can be used, but none is perfect. A stool culture can be positive in someone without diarrhea, ie, a carrier. While the cytotoxin is the gold standard, it is expensive, and there is a delay before results are available. Thus, many laboratories use the enzyme-linked immunoassay tests to detect toxin of C difficile because they are a more rapid screen. Depending on the specific test used, they can detect toxin A, toxin B or occasionally both. Sensitivity and specificity rates vary. First line therapy for C difficile disease should be metronidazole 250 mg qid for 10 days. Vancomycin should be reserved for severe cases where metronidazole has failed or where metronidazole cannot be tolerated or is contraindicated. Recurrent C difficile disease is a particularly vexing clinical problem. A variety of biotherapeutic approaches have been used. Retreatment with antibiotics is almost always necessary. In addition, the nonpathogenic yeast Saccharomyces boulardii has been showed to be of benefit as an adjunct in preventing further recurrences.
艰难梭菌是最常见的医院获得性胃肠道感染病原体。大多数病例与抗生素治疗有关，抗生素治疗会改变粪便菌群，使艰难梭菌过度生长并产生毒素。通过检测粪便中的病原体或毒素进行诊断。可使用多种不同的检测方法，但没有一种是完美的。粪便培养在没有腹泻的人（即携带者）中可能呈阳性。虽然细胞毒素检测是金标准，但它成本高，且结果出来前有延迟。因此，许多实验室使用酶联免疫分析检测艰难梭菌毒素，因为它们是更快的筛查方法。根据所使用的具体检测方法，它们可以检测毒素A、毒素B，偶尔也能检测两者。灵敏度和特异度有所不同。艰难梭菌疾病的一线治疗应为甲硝唑250毫克，每日4次，共10天。万古霉素应保留用于甲硝唑治疗失败、无法耐受甲硝唑或甲硝唑禁忌的严重病例。复发性艰难梭菌疾病是一个特别棘手的临床问题。已经使用了多种生物治疗方法。几乎总是需要用抗生素再次治疗。此外，非致病性酵母布拉氏酵母菌已被证明作为辅助手段在预防进一步复发方面有益。
