Samore M H
University of Utah School of Medicine, Department of Internal Medicine, Salt Lake City, Utah 84132, USA.
J Hosp Infect. 1999 Dec;43 Suppl:S183-90. doi: 10.1016/s0195-6701(99)90085-3.
Clostridium difficile is a frequent and clinically important cause of diarrhoea that has been strongly but not exclusively associated with the hospital setting. The vast majority of cases of C. difficile diarrhoea are associated with antecedent treatment with antibiotics, of which cephalosporins and clindamycin appear to pose the highest risk. Within hospitals and chronic-care facilities, cross-infection of C. difficile has been related to transient carriage on hands of healthcare workers and contamination of diverse environmental surfaces, including electronic rectal thermometers. Prospective epidemiologic studies have demonstrated that acquisition of C. difficile is common in hospitalized patients. Although colonized patients contribute to nosocomial transmission of C. difficile, symptom-free carriage of C. difficile appears to reduce risk of subsequent development of C. difficile diarrhoea. Antimicrobial treatment with oral metronidazole or vancomycin to attempt to eradicate symptomless carriage is not recommended. Measures to control nosocomial C. difficile diarrhoea have focused on improved handwashing, use of barrier precautions with single rooms for symptomatic patients, reduction of environmental contamination, and antibiotic restriction. Restricting clindamycin has been particularly successful in terminating outbreaks of C. difficile diarrhoea associated with its use. The epidemiologic features of C. difficile and strategies for control are similar to those for micro-organisms that have acquired antimicrobial resistance. C. difficile may be indirectly or directly contributing to spread of resistant organisms, for instance, by causing diarrhoea and thereby enhancing environmental contamination with other gastrointestinal flora such as vancomycin-resistant enterococci. Thus, a consideration of C. difficile in the larger context of the world-wide spread of antibiotic resistance offers useful insights that may help form the basis for the development of more effective control measures.
艰难梭菌是腹泻的常见且具有临床重要性的病因，与医院环境密切相关，但并非唯一相关因素。绝大多数艰难梭菌腹泻病例与先前使用抗生素治疗有关，其中头孢菌素和克林霉素似乎风险最高。在医院和长期护理机构中，艰难梭菌的交叉感染与医护人员手部的短暂携带以及包括电子直肠温度计在内的各种环境表面的污染有关。前瞻性流行病学研究表明，住院患者中艰难梭菌的获得很常见。虽然定植患者会导致艰难梭菌的医院内传播，但无症状携带艰难梭菌似乎会降低随后发生艰难梭菌腹泻的风险。不建议使用口服甲硝唑或万古霉素进行抗菌治疗以试图根除无症状携带。控制医院内艰难梭菌腹泻的措施主要集中在改善洗手、对有症状患者使用单间隔离预防措施、减少环境污染以及限制使用抗生素。限制使用克林霉素在终止与其使用相关的艰难梭菌腹泻暴发方面特别成功。艰难梭菌的流行病学特征和控制策略与获得抗菌药物耐药性的微生物相似。艰难梭菌可能通过间接或直接方式促进耐药菌的传播，例如，通过引起腹泻，从而增加其他胃肠道菌群（如耐万古霉素肠球菌）对环境的污染。因此，在抗生素耐药性全球传播的大背景下考虑艰难梭菌，能提供有用的见解，可能有助于形成制定更有效控制措施的基础。
