Altindiş Mustafa, Usluer Sibel, Ciftçi Hakki, Tunç Nedim, Cetinkaya Zafer, Aktepe O Cem
Afyon Kocatepe Universitesi Tip Fakültesi, Klinik Mikrobiyoloji Anabilim Dali, Afyonkarahisar.
Mikrobiyol Bul. 2007 Jan;41(1):29-37.
Clostridium difficile-associated disease can be observed especially in hospitalized patients who use broad-spectrum antibiotics. The aim of this study was to investigate the presence of C. difficile as the causative agent of diarrhea in outpatients and inpatients. During January-December 2005, 45 outpatients and 46 inpatients (of them 11 were intensive care unit patients) who had developed diarrhea due to antibiotic use, were included to the study. In addition 7 intensive care unit personnel and 20 food handlers were also included to the study in order to detect their carrier states. The age range of patients was 16-80 years, and of them 45 (49.5%) were male, while the age range of the personnel was 25-55 years, and of them 21 (78%) were male. Stool samples collected from the study groups were cultivated in C. difficile agar media (C. difficile Agar Base, Oxoid) as well as on routine bacteriologic media, and C. difficile growth was confirmed by latex agglutination test with the use of specific antisera. The presence of C. difficile toxin A was investigated by latex method (Oxoid, UK), and toxin A and B was searched by enzyme-linked immunoassay (ELISA; Seramun GmbH, Serazym C. difficile Toxin A+B), in the stool samples. While C. difficile was isolated from 13 (14.3%) of the 91 samples, no positive result was detected in the personnel. There was no statistically significant difference between outpatient and inpatient groups by means of C. difficile culture positivity (15.5% and 17.1%, respectively) (p>0.05). All of the culture positive samples were also found positive by ELISA Toxin A+B method (100%), but only 4 of them (30.7%) yielded positive result by Toxin A latex test. It was detected that 84.6% (11/13) of the patients had used ampicillin/sulbactam, 7.7% (1/13) used cotrimoxazole-SXT, and 7.7% (1/13) used macrolide antibiotics. The use of ampicillin/sulbactam was found statistically significant in development of diarrhea (p<0.05). Our data indicated that ELISA Toxin A+B is a reliable method with 100% specificity and sensitivity in the rapid diagnosis of C. difficile until the culture results were obtained, however, although specificity of Toxin A latex test is 100%, its use alone as a primary rapid diagnostic test was not recommended because of its low (30.7%) sensitivity.
艰难梭菌相关性疾病尤其在使用广谱抗生素的住院患者中较为常见。本研究旨在调查门诊患者和住院患者中作为腹泻病原体的艰难梭菌的存在情况。在2005年1月至12月期间，45名门诊患者和46名住院患者（其中11名是重症监护病房患者）因使用抗生素而出现腹泻，被纳入本研究。此外，7名重症监护病房工作人员和20名食品处理人员也被纳入研究以检测其携带状态。患者的年龄范围为16至80岁，其中45名（49.5%）为男性，而工作人员的年龄范围为25至55岁，其中21名（78%）为男性。从研究组采集的粪便样本在艰难梭菌琼脂培养基（Oxoid公司的艰难梭菌琼脂基础培养基）以及常规细菌学培养基上培养，通过使用特异性抗血清的乳胶凝集试验确认艰难梭菌的生长。通过乳胶法（英国Oxoid公司）研究粪便样本中艰难梭菌毒素A的存在情况，并通过酶联免疫吸附测定法（ELISA；德国Seramun GmbH公司的Serazym艰难梭菌毒素A + B）检测毒素A和B。在91份样本中，有l3份（14.3%）分离出艰难梭菌，而在工作人员中未检测到阳性结果。门诊患者组和住院患者组在艰难梭菌培养阳性率方面无统计学显著差异（分别为15.5%和17.1%）（p>0.05）。所有培养阳性样本通过ELISA毒素A + B法检测也均为阳性（100%），但其中只有4份（30.7%）通过毒素A乳胶试验产生阳性结果。检测发现84.6%（11/13）的患者使用过氨苄西林/舒巴坦，7.7%（1/13）使用过复方新诺明（SXT），7.7%（1/13）使用过大环内酯类抗生素。发现使用氨苄西林/舒巴坦与腹泻的发生在统计学上具有显著意义（p<0.05）。我们的数据表明，在获得培养结果之前，ELISA毒素A + B是一种在快速诊断艰难梭菌方面具有100%特异性和敏感性的可靠方法，然而，尽管毒素A乳胶试验的特异性为100%，但由于其低敏感性（30.7%），不建议单独将其作为主要的快速诊断试验。
