Joshy L, Chaudhry R, Dhawan B, Kumar L, Das B K
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
J Hosp Infect. 2006 Jul;63(3):323-9. doi: 10.1016/j.jhin.2005.12.015. Epub 2006 May 2.
Clostridium perfringens has been reported as causing between 2-15% of all cases of antibiotic-associated diarrhoea (AAD), and may be diagnosed by detection of enterotoxin in faeces. A prospective study comprising 150 diarrhoeal patients and 100 non-diarrhoeal controls was undertaken to assess the incidence of C. perfringens-associated diarrhoea in an Indian hospital. Methods used included C. perfringens culture, reverse passive latex agglutination (RPLA) and enzyme-linked immunosorbent assay (ELISA) for detection of enterotoxin, and polymerase chain reaction (PCR) assay for the presence of enterotoxin gene. Attempts were made to type the isolates by multiplex PCR. Of the 150 diarrhoeal stool samples tested, 13 were culture positive. Of these, four were positive for C. perfringens enterotoxin by RPLA, two were positive by PCR and two were positive by RPLA and ELISA. Twenty-seven samples were positive for culture of C. perfringens in non-diarrhoeal controls but none were positive for enterotoxin either by RPLA or by PCR. The average incidence of C. perfringens AAD using these methods was 2.6%. Toxin typing showed that all the isolates belonged to type A. To conclude, the relatively low incidence of toxigenic C. perfringens suggests that enterotoxigenic C. perfringens is not a major cause of AAD in this population.
据报道，产气荚膜梭菌导致的抗生素相关性腹泻（AAD）病例占所有病例的2%-15%，可通过检测粪便中的肠毒素进行诊断。开展了一项前瞻性研究，纳入150例腹泻患者和100例非腹泻对照，以评估一家印度医院中产气荚膜梭菌相关性腹泻的发病率。使用的方法包括产气荚膜梭菌培养、反向被动乳胶凝集试验（RPLA）和酶联免疫吸附测定（ELISA）检测肠毒素，以及聚合酶链反应（PCR）检测肠毒素基因的存在。尝试通过多重PCR对分离株进行分型。在检测的150份腹泻粪便样本中，13份培养呈阳性。其中，4份通过RPLA检测产气荚膜梭菌肠毒素呈阳性，2份通过PCR呈阳性，2份通过RPLA和ELISA呈阳性。27份非腹泻对照样本产气荚膜梭菌培养呈阳性，但通过RPLA或PCR检测肠毒素均为阴性。使用这些方法检测产气荚膜梭菌AAD的平均发病率为2.6%。毒素分型显示所有分离株均属于A型。总之，产毒产气荚膜梭菌的发病率相对较低，表明产肠毒素产气荚膜梭菌不是该人群AAD的主要病因。
