Bartlett John G, Gerding Dale N
Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Clin Infect Dis. 2008 Jan 15;46 Suppl 1:S12-8. doi: 10.1086/521863.
Prompt and precise diagnosis is an important aspect of effective management of Clostridium difficile infection (CDI). CDI causes 15%-25% of all cases of antibiotic-associated diarrhea, the severity of which ranges from mild diarrhea to fulminant pseudomembranous colitis. Several factors, especially advanced age and hospitalization, should be considered in the diagnosis of CDI. In particular, nosocomial diarrhea arising >72 hours after admission among patients receiving antibiotics is highly likely to have resulted from CDI. Testing of stool for the presence of C. difficile toxin confirms the diagnosis of CDI. However, performance of an enzyme immunoassay is the usual method by which CDI is confirmed, but this test appears to be relatively insensitive, compared with the cell cytotoxicity assay and stool culture for toxigenic C. difficile on selective medium. Endoscopy and computed tomography are less sensitive than stool toxin assays but may be useful when immediate results are important or other confounding conditions rank high in the differential diagnosis. Often overlooked aspects of this diagnosis are high white blood cell counts (which are sometimes in the leukemoid range) and hypoalbuminemia.
及时准确的诊断是艰难梭菌感染（CDI）有效管理的一个重要方面。CDI导致所有抗生素相关性腹泻病例的15% - 25%，其严重程度从轻度腹泻到暴发性假膜性结肠炎不等。在CDI的诊断中应考虑几个因素，尤其是高龄和住院情况。特别是，接受抗生素治疗的患者入院72小时后出现的医院内腹泻很可能是由CDI引起的。检测粪便中是否存在艰难梭菌毒素可确诊CDI。然而，酶免疫测定是确诊CDI的常用方法，但与细胞毒性试验和在选择性培养基上对产毒艰难梭菌进行粪便培养相比，该试验似乎相对不敏感。内镜检查和计算机断层扫描比粪便毒素检测的敏感性低，但在需要即时结果或其他混淆情况在鉴别诊断中占比高时可能有用。该诊断中经常被忽视的方面是白细胞计数高（有时处于类白血病范围）和低白蛋白血症。
