Bauer M P, Goorhuis A, Koster T, Numan-Ruberg S C, Hagen E C, Debast S B, Kuijper E J, van Dissel J T
Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
Neth J Med. 2008 May;66(5):207-11.
The emergence of hypervirulent strains of Clostridium difficile causing outbreaks in hospitals and nursing homes may result in a greater than before spread of the bacterium in the community. By consequence, the incidence of community-onset cases of Clostridium difficile-associated diarrhoea (CDAD) may increase outside known risk groups that are currently characterised by prior hospitalisation, prior antibiotic usage, older age and significant comorbidity. Here, we describe two case histories of community-onset CDAD. The first concerns a previously healthy young female with community-acquired CDAD without recent hospitalisation or antibiotic usage. The second patient developed diarrhoea in the community after discharge from a hospital where--in retrospect--an outbreak of CDAD occurred. The cases illustrate that CDAD should be included in the differential diagnosis of patients seeking care for community-onset diarrhoea, even in those without characteristic risk factors for CDAD.
艰难梭菌高毒力菌株在医院和疗养院引发疫情，可能导致该细菌在社区中的传播比以往更为广泛。因此，艰难梭菌相关性腹泻（CDAD）社区发病病例的发生率可能会在目前以既往住院史、既往抗生素使用史、老年和严重合并症为特征的已知风险人群之外增加。在此，我们描述两例社区发病的CDAD病例。第一例涉及一名此前健康的年轻女性，她患有社区获得性CDAD，近期无住院或抗生素使用史。第二例患者在一家医院出院后在社区出现腹泻，回顾发现该医院曾发生CDAD疫情。这些病例表明，即使是没有CDAD特征性危险因素的患者，在因社区发病腹泻就医时，CDAD也应纳入鉴别诊断。
