艰难梭菌感染:流行病学、危险因素、发病机制、临床特征、诊断与治疗
[Clostridium difficile infection: epidemiology, risk factors, pathogenesis, clinical features, diagnosis and therapy].
作者信息
Kılıç Abdullah
机构信息
Gulhane Military Academy of Medicine, Department of Medical Microbiology, Ankara, Turkey.
出版信息
Mikrobiyol Bul. 2013 Jul;47(3):556-66. doi: 10.5578/mb.5208.
Clostridium difficile is a gram-positive, spore-forming anaerobic bacterium. C.difficile is the leading cause of antibiotic associated diarrhea and colitis. The clinical spectrum of C.difficile infection (CDI) is highly variable, ranging from mild diarrhea to severe forms of intestinal illness including toxic megacolon, ileus, bowel perforation, and pseudomembranous colitis. Advanced age, long duration of hospitalization, and exposure to certain antimicrobial agents are the most common risk factors for CDI. The main virulence determinants of C.difficile are toxin A (enterotoxin) and toxin B (cytotoxin). Diagnosis of CDI is based on the identification of C.difficile toxin A or B in diarrheal stool. Various laboratory tests have been currently developed for the detection of C.difficile or its toxins in stool samples. The cell culture cytotoxicity assay and toxigenic culture have been regarded as the reference standard methods for the detection of C.difficile toxins. However, both of the reference methods are laborious, time consuming, and need expert personnel. Therefore, many microbiology laboratories use enzyme immunoassays, glutamate dehydrogenase antigen tests and real-time polymerase chain reaction (PCR) which are more rapid and practical. First-line antibiotics for CDI treatment are metronidazole and vancomycin. In this review, epidemiology, clinical spectrum, risk factors, pathogenesis, diagnostic methods and treatment of CDI have been summarized.
艰难梭菌是一种革兰氏阳性、形成芽孢的厌氧菌。艰难梭菌是抗生素相关性腹泻和结肠炎的主要病因。艰难梭菌感染(CDI)的临床谱变化很大,从轻度腹泻到严重的肠道疾病形式,包括中毒性巨结肠、肠梗阻、肠穿孔和假膜性结肠炎。高龄、长期住院以及接触某些抗菌药物是CDI最常见的危险因素。艰难梭菌的主要毒力决定因素是毒素A(肠毒素)和毒素B(细胞毒素)。CDI的诊断基于在腹泻粪便中鉴定出艰难梭菌毒素A或B。目前已经开发了各种实验室检测方法来检测粪便样本中的艰难梭菌或其毒素。细胞培养细胞毒性试验和产毒培养被视为检测艰难梭菌毒素的参考标准方法。然而,这两种参考方法都费力、耗时,并且需要专业人员。因此,许多微生物实验室使用酶免疫测定、谷氨酸脱氢酶抗原检测和实时聚合酶链反应(PCR),这些方法更快速、实用。CDI治疗的一线抗生素是甲硝唑和万古霉素。在这篇综述中,总结了CDI的流行病学、临床谱、危险因素、发病机制、诊断方法和治疗。