Gogate A, De A, Nanivadekar R, Mathur M, Saraswathi K, Jog A, Kulkarni M V
Department of Microbiology , L.T.M. Medical College, Mumbai, India.
Indian J Med Res. 2005 Dec;122(6):518-24.
BACKGROUND & OBJECTIVE: Mere diagnosis of Clostridium difficile by culture does not help in the diagnosis of antibiotic associated diarrhoeae (AAD) due to C. difficile. Detection of toxins A and B form the mainstay in the diagnosis of AAD due to C. difficile. This study was undertaken to find out the role of stool culture and toxin detection in the diagnosis of AAD due to C. difficile. As there are very few documented reports from India about AAD due to C. difficile in children in the age group of 5-12 yr, this age group was selected.
Faecal samples were collected from 250 hospitalized children in the age group of 5-12 yr who developed diarrhoea on receiving antibiotics for different medical problems for more than five days duration. Also faecal samples of 250 age and sex matched controls were collected. Culture for C. difficile was done on cycloserine cefoxitin fructose egg yolk agar (CCFA) and colonies were identified by standard laboratory techniques. ELISA for toxins A and B detection and tissue culture on HeLa cells for toxin B detection were also done.
Overall positivity was 18 per cent in this study group compared to the controls (P<0.001). Maximum positive cases were in 5-8 yr age group (84.4%). Severe diarrhoea, liquid stool with mucus and blood, faecal leucocytes >5/high power field, altered flora and presence of Gram-positive bacilli with oval subterminal spores on Gram stain were sensitive predictors for diagnosis of AAD due to C. difficile. Amongst positive cases, 68.9 per cent responded to discontinuation of antibiotics and 31.1 per cent to metronidazole therapy.
INTERPRETATION & CONCLUSION: C. difficile was an important pathogen responsible for antibiotic associated diarrhoea (AAD) in children of 5-12 yr age group. Conservative use of antibiotics would be beneficial to decrease the incidence of AAD.
仅通过培养诊断艰难梭菌无助于诊断由艰难梭菌引起的抗生素相关性腹泻（AAD）。毒素A和B的检测是诊断由艰难梭菌引起的AAD的主要依据。本研究旨在探讨粪便培养和毒素检测在诊断由艰难梭菌引起的AAD中的作用。由于印度关于5至12岁儿童由艰难梭菌引起的AAD的文献报道极少，因此选择了该年龄组。
收集了250名年龄在5至12岁、因不同医疗问题接受抗生素治疗超过5天且出现腹泻的住院儿童的粪便样本。同时收集了250名年龄和性别匹配的对照儿童的粪便样本。在环丝氨酸头孢西丁果糖蛋黄琼脂（CCFA）上进行艰难梭菌培养，并通过标准实验室技术鉴定菌落。还进行了毒素A和B的ELISA检测以及在HeLa细胞上进行毒素B检测的组织培养。
与对照组相比，本研究组的总体阳性率为18%（P<0.001）。阳性病例最多的是5至8岁年龄组（84.4%）。严重腹泻、伴有黏液和血液的水样便、粪便白细胞>5/高倍视野、菌群改变以及革兰氏染色显示有带椭圆形亚末端孢子的革兰氏阳性杆菌是诊断由艰难梭菌引起的AAD的敏感预测指标。在阳性病例中，68.9%对抗生素停用有反应，31.1%对甲硝唑治疗有反应。
艰难梭菌是5至12岁儿童抗生素相关性腹泻（AAD）的重要病原体。谨慎使用抗生素将有助于降低AAD的发生率。
