Krausz S, Bessems M, Boermeester M A, Kuijper E J, Visser C E, Speelman P
Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
Ned Tijdschr Geneeskd. 2005 Sep 17;149(38):2081-6.
Three men, aged 39, 73, and 66 years, respectively, developed an infection with a new strain ofClostridium difficile, ribotype 027.C.difficile-associated diarrhoea (CDAD) occurred in two patients after multiple abdominal surgery and in the third patient one week after autologous haematopoietic cell transplantation. Within a few days, despite antibiotic therapy, all three patients developed severe (pseudomembranous) colitis with sepsis for which admission to the Intensive Care Unit was required. Two patients underwent (sub)total colectomy and received an intensive course of oral and/or rectal vancomycin. In all patients who develop diarrhoea in hospital, especially during or after treatment with antibiotics or chemotherapeutic agents, an infection with C. difficile ribotype 027 should be suspected. Recent outbreaks of this hypervirulent strain of C. difficile have been reported in Canada, the United States, United Kingdom, and The Netherlands. Demonstration of C. difficile toxin in faeces confirms the clinical suspicion of CDAD and ribotyping of the strain may reveal whether the 027 strain is present. For treatment of these 027 infections, vancomycin is preferred to metronidazole. After a severe course of colitis or in case of recurrence a 'tapering and pulse' course ofvancomycin can be prescribed; alternatively, treatment with bovine antibody-enriched whey may be considered. The introduction of this hypervirulent strain has led to reinforcement of the hygienic measures in accordance with the recommendations of the Dutch Working Party on Infection Prevention and a policy to deter the use of fluoroquinolones.
三名男子，年龄分别为39岁、73岁和66岁，感染了一种艰难梭菌的新菌株，核糖体分型为027。两名患者在多次腹部手术后发生了艰难梭菌相关性腹泻（CDAD），第三名患者在自体造血细胞移植一周后出现该病症。在几天内，尽管进行了抗生素治疗，所有三名患者都发展为严重的（假膜性）结肠炎并伴有败血症，因此需要入住重症监护病房。两名患者接受了（次）全结肠切除术，并接受了强化的口服和/或直肠万古霉素疗程。对于所有在医院发生腹泻的患者，尤其是在使用抗生素或化疗药物期间或之后，应怀疑感染了核糖体分型为027的艰难梭菌。最近在加拿大、美国、英国和荷兰都报告了这种高毒力艰难梭菌菌株的暴发。粪便中艰难梭菌毒素的检测证实了对CDAD的临床怀疑，对该菌株进行核糖体分型可能会揭示是否存在027菌株。对于这些027感染的治疗，万古霉素比甲硝唑更受青睐。在经历严重的结肠炎病程后或复发时，可以开具“逐渐减量和脉冲式”万古霉素疗程；或者，可以考虑用富含牛抗体的乳清进行治疗。这种高毒力菌株的出现导致根据荷兰感染预防工作小组的建议加强了卫生措施，并制定了一项限制使用氟喹诺酮类药物的政策。
