Markowitz J E, Brown K A, Mamula P, Drott H R, Piccoli D A, Baldassano R N
Divisions of Gastroenterology & Nutrition and Clinical Laboratories, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Am J Gastroenterol. 2001 Sep;96(9):2688-90. doi: 10.1111/j.1572-0241.2001.04125.x.
The aims of this retrospective study were 1) to determine the ability of single-toxin assays for Clostridium difficile to detect infection among pediatric patients with inflammatory bowel disease (IBD) and 2) to determine the toxin assays routinely used by pediatric tertiary care hospitals in the United States.
Stool specimens from patients with IBD (submitted from January, 1996, to August, 1999) were evaluated for the presence of C. difficile toxin A and toxin B. Toxin profile (toxin A alone, toxin B alone, toxin A and B together) was compared in positive specimens. A phone interview was conducted with representatives from laboratories in 22 pediatric hospitals to investigate which toxin assays were routinely used.
A total of 697 specimens were submitted from 284 IBD patients. In all, 81 IBD patients (28.5%) had at least one documented infection. Toxin A assay failed to identify 41.5% of C. difficile infections. Toxin B assay failed to detect 34.9% of C. difficile infections. Toxin profile changed in 55% of patients with multiple infections. Of the hospitals surveyed, 59% did not test for both toxins.
Single-toxin assays for C. difficile fail to detect a significant percentage of infections. The toxins identified during one infection are not predictive of the toxins identified in subsequent infections. Despite this, many pediatric hospitals do not routinely use both toxin assays to diagnose C. difficile infection. When infection is suspected, assays for C. difficile toxin A and toxin B should be requested.
本回顾性研究的目的是：1）确定艰难梭菌单毒素检测在炎症性肠病（IBD）儿科患者中检测感染的能力；2）确定美国儿科三级护理医院常规使用的毒素检测方法。
对1996年1月至1999年8月提交的IBD患者粪便标本进行艰难梭菌毒素A和毒素B检测。对阳性标本的毒素谱（单独毒素A、单独毒素B、毒素A和B同时存在）进行比较。对22家儿科医院实验室的代表进行电话访谈，以调查常规使用哪些毒素检测方法。
共收到284例IBD患者的697份标本。总计，81例IBD患者（28.5%）至少有一次记录在案的感染。毒素A检测未能识别41.5%的艰难梭菌感染。毒素B检测未能检测出34.9%的艰难梭菌感染。55%的多次感染患者毒素谱发生变化。在接受调查的医院中，59%未对两种毒素进行检测。
艰难梭菌单毒素检测未能检测出相当比例的感染。一次感染中鉴定出的毒素不能预测后续感染中鉴定出的毒素。尽管如此，许多儿科医院并未常规使用两种毒素检测来诊断艰难梭菌感染。当怀疑感染时，应要求进行艰难梭菌毒素A和毒素B检测。
