Bujanda Luis, Cosme Angel
Servicio de Aparato Digestivo, Hospital Donostia, Centro de Investigación Biomédica en Enfermedades Hepáticas y Digestivas (CIBEREHD), San Sebastián, España.
Gastroenterol Hepatol. 2009 Jan;32(1):48-56. doi: 10.1016/j.gastrohep.2008.02.003. Epub 2008 Dec 31.
Clostridium difficile is the most frequent cause of nosocomial diarrhea and is a significant cause of morbidity among hospitalized patients. The inflammation is produced as a result of a non-specific response to toxins. In the last few years, a hypervirulent strain, NAP1/BI/027, has been reported. Symptoms usually consist of abdominal pain and diarrhea. The diagnosis should be suspected in any patient who develops diarrhea during antibiotic therapy or 6-8 weeks after treatment. Diagnosis should be confirmed by the detection of CD toxin in stool and by colonoscopy in special situations. The treatment of choice is metronidazole or vancomycin. In some patients who do not respond to this therapy or who have complications, subtotal colectomy may be required. Relapse is frequent and must be distinguished from reinfection. Prevention and control in healthcare settings requires careful attention.
艰难梭菌是医院获得性腹泻最常见的病因,也是住院患者发病的重要原因。炎症是对毒素的非特异性反应所致。在过去几年里,已报告了一种高毒力菌株,即NAP1/BI/027。症状通常包括腹痛和腹泻。对于任何在抗生素治疗期间或治疗后6至8周出现腹泻的患者,都应怀疑有该诊断。诊断应通过粪便中艰难梭菌毒素检测以及在特殊情况下通过结肠镜检查来确认。首选治疗药物是甲硝唑或万古霉素。对于一些对这种治疗无反应或有并发症的患者,可能需要进行次全结肠切除术。复发很常见,必须与再次感染相区分。医疗机构中的预防和控制需要密切关注。