Department of Surgery, Penn State College of Medicine, 500 University Drive, H137, Hershey, PA 17033, USA.
J Gastrointest Surg. 2013 Jan;17(1):118-24; discussion p.124-5. doi: 10.1007/s11605-012-2056-6. Epub 2012 Oct 20.
Recurrent Clostridium difficile colitis is common, yet the ability to predict recurrence is poorly developed.
Patients ≥18 years of age treated at our institution for C. difficile of any severity were consecutively enrolled. C. difficile colitis was defined as symptoms of colitis with a positive PCR stool test. Each bacterial isolate was studied for virulence factors: tcdC mutations via PCR; the presence of genes for toxins A, B, and binary toxin using restriction fragment length polymorphism; and identification of ribotype 027 by PCR. Chi-squared tests, t tests, and logistic and linear regression were used to determine which virulence factors predicted recurrence.
Sixty-nine patients (male, 57 %) were studied, with a mean age of 64 ± 13 years. Twenty-one (30 %) patients were initially diagnosed as outpatients. There was no difference (p > 0.05) between virulence factors among inpatients and outpatients. The presence of a binary toxin gene was the single virulence factor independently associated with recurrence (p = 0.02). The combination of a tcdC mutation with binary toxin gene resulted in the highest odds of recurrence (OR, 5.3; 95 % CI, 3.52-6.09).
Binary toxin gene is a predictor of recurrent infection. Its presence may require longer antibiotic regimens in an effort to lower already elevated recurrence rates.
复发性艰难梭菌结肠炎很常见，但预测复发的能力尚未得到充分发展。
连续纳入在我院接受治疗的任何严重程度的艰难梭菌感染的年龄≥18 岁的患者。艰难梭菌结肠炎的定义为结肠炎症状和阳性 PCR 粪便检测。对每个细菌分离株进行毒力因子研究：通过 PCR 检测 tcdC 突变；使用限制性片段长度多态性检测毒素 A、B 和二元毒素的基因存在；通过 PCR 鉴定核糖体型 027。使用卡方检验、t 检验、逻辑回归和线性回归来确定哪些毒力因子预测复发。
共纳入 69 例患者（男性 57%），平均年龄为 64±13 岁。21 例（30%）患者最初被诊断为门诊患者。住院患者和门诊患者之间的毒力因子无差异（p>0.05）。二元毒素基因的存在是与复发独立相关的唯一毒力因子（p=0.02）。tcdC 突变与二元毒素基因的组合导致复发的可能性最高（OR，5.3；95%CI，3.52-6.09）。
二元毒素基因是感染复发的预测因子。其存在可能需要更长的抗生素治疗方案，以降低已经升高的复发率。
