Tabibian N, Clarridge J E, Smith J L, Alpert E, Shaw I, Graham D Y
South Med J. 1987 Jun;80(6):709-11. doi: 10.1097/00007611-198706000-00011.
Campylobacter jejuni has emerged as a frequent cause of diarrhea. During a 12-month period at the Houston Veterans Administration Medical Center, we isolated C jejuni from 3.4% of the 290 stool cultures from patients with diarrhea. This compared to an isolation rate of 4.1% for Salmonella and 3.1% for Shigella. During the same period, 17 additional cases of Campylobacter-associated diarrhea were identified in adults at the two other Baylor College of Medicine teaching hospitals. We correlated the clinical history, treatment, and outcome of these 27 cases of Campylobacter-associated diarrhea (22 cases of acute diarrhea and five of chronic diarrhea). In most patients with acute disease, the diarrhea was resolving by the time the results of the cultures were available. The duration of illness was the same whether treated with antibiotics to which Campylobacter was susceptible (effective therapy) or antibiotics to which it was not susceptible (ineffective therapy); the mean duration of diarrhea after submitting the culture was 5.2 days for those with ineffective therapy versus 5.6 days for those receiving effective therapy. Thus, antibiotic therapy did not appear to shorten the duration of acute diarrhea due to Campylobacter. Five patients had chronic diarrhea; all had an unrelated underlying disease, and antibiotic treatment did not change the clinical course despite bacteriologic cure. This study raises questions as to the value of antibiotic therapy for campylobacteriosis, and in this light, we discuss the value of routine culturing for Campylobacter.
空肠弯曲菌已成为腹泻的常见病因。在休斯顿退伍军人管理局医疗中心为期12个月的时间里，我们从290例腹泻患者的粪便培养物中分离出空肠弯曲菌，分离率为3.4%。相比之下，沙门氏菌的分离率为4.1%，志贺氏菌为3.1%。同一时期，在另外两家贝勒医学院教学医院的成人中又确诊了17例弯曲菌相关性腹泻病例。我们对这27例弯曲菌相关性腹泻病例（22例急性腹泻和5例慢性腹泻）的临床病史、治疗及转归进行了对比分析。在大多数急性病患者中，培养结果出来时腹泻已在缓解。无论用对弯曲菌敏感的抗生素（有效治疗）还是不敏感的抗生素（无效治疗），病程都是一样的；培养后腹泻的平均持续时间，无效治疗组为5.2天，有效治疗组为5.6天。因此，抗生素治疗似乎并未缩短弯曲菌所致急性腹泻的病程。5例患者有慢性腹泻；他们都有不相关的基础疾病，尽管细菌学上已治愈，但抗生素治疗并未改变临床病程。这项研究引发了关于弯曲菌病抗生素治疗价值的疑问，据此，我们讨论了弯曲菌常规培养的价值。
