Schroeder Michael S
Kaiser Permanente, Family Medicine Residency Program, Fontana, California 92335, USA.
Am Fam Physician. 2005 Mar 1;71(5):921-8.
Clostridium difficile infection is responsible for approximately 3 million cases of diarrhea and colitis annually in the United States. The mortality rate is 1 to 2.5 percent. Early diagnosis and prompt aggressive treatment are critical in managing C. difficile-associated diarrhea. Major predisposing factors for symptomatic C. difficile colitis include antibiotic therapy; advanced age; multiple, severe underlying diseases; and a faulty immune response to C. difficile toxins. The most common confirmatory study is an enzyme immunoassay for C. difficile toxins A and B. The test is easy to perform, and results are available in two to four hours. Specificity of the assay is high (93 to 100 percent), but sensitivity ranges from 63 to 99 percent. In severe cases, flexible sigmoidoscopy can provide an immediate diagnosis. Treatment of C. difficile-associated diarrhea includes discontinuation of the precipitating antibiotic (if possible) and the administration of metronidazole or vancomycin. Preventive measures include the judicious use of antibiotics, thorough hand washing between patient contacts, use of precautions when handling an infected patient or items in the patient's immediate environment, proper disinfection of objects, education of staff members, and isolation of the patient.
在美国，艰难梭菌感染每年导致约300万例腹泻和结肠炎病例。死亡率为1%至2.5%。早期诊断和及时积极治疗对于管理艰难梭菌相关性腹泻至关重要。有症状的艰难梭菌结肠炎的主要易感因素包括抗生素治疗、高龄、多种严重基础疾病以及对艰难梭菌毒素的免疫反应缺陷。最常见的确诊检查是检测艰难梭菌毒素A和B的酶免疫测定。该检测易于操作，两到四小时即可出结果。该测定的特异性较高（93%至100%），但灵敏度范围为63%至99%。在严重病例中，乙状结肠镜检查可提供即时诊断。艰难梭菌相关性腹泻的治疗包括停用引发感染的抗生素（如有可能），并给予甲硝唑或万古霉素。预防措施包括合理使用抗生素、在接触患者之间彻底洗手、在处理感染患者或其直接环境中的物品时采取预防措施、对物品进行适当消毒、对工作人员进行教育以及隔离患者。
