Talbot R W, Walker R C, Beart R W
Br J Surg. 1986 Jun;73(6):457-60. doi: 10.1002/bjs.1800730614.
One hundred and ninety patients with Clostridium difficile toxin-associated colitis (CTAC) or pseudomembranous colitis (PMC) were identified, from microbiology records, disease index and proctoscopy service records, and studied retrospectively. CTAC was associated with cephalosporin antibiotic administration in 70 per cent of the patients. CTAC developed postoperatively in 108 patients after all types of surgery with no preponderance for abdominal surgery. Identification of cytotoxin in stool samples was the primary diagnostic test in 81 per cent of patients but cytotoxin was isolated in 98 per cent of all patients. Pseudomembranes visible on proctoscopy established the diagnosis in 19 per cent of patients and were more commonly seen in severe colitis (71 per cent) than in mild colitis (23 per cent). CTAC responded similarly to oral vancomycin and metronidazole with a relapse rate of 20-23 per cent, respectively. With its association with cephalosporin administration, CTAC is likely to occur with increasing frequency in surgical practice. Oral metronidazole is an effective, cheap, alternative to vancomycin therapy.
通过微生物学记录、疾病索引和直肠镜检查服务记录，共识别出190例艰难梭菌毒素相关性结肠炎（CTAC）或假膜性结肠炎（PMC）患者，并进行回顾性研究。70%的患者的CTAC与头孢菌素类抗生素的使用有关。108例患者在接受各类手术后发生CTAC，腹部手术并无明显优势。81%的患者粪便样本中细胞毒素的鉴定是主要诊断测试，但98%的患者均分离出细胞毒素。直肠镜检查中可见的假膜在19%的患者中确立了诊断，在重症结肠炎（71%）中比轻症结肠炎（23%）中更常见。CTAC对口服万古霉素和甲硝唑的反应相似，复发率分别为20%-23%。鉴于其与头孢菌素使用的关联，CTAC在外科实践中的发生率可能会越来越高。口服甲硝唑是一种有效、廉价的万古霉素替代疗法。
