Ichiyama Saaya, Soma Shunsuke, Ito Katsunori
Emergency and Disaster Department, Hirosaki University, Hiorosaki, JPN.
Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, JPN.
Cureus. 2023 Jul 13;15(7):e41804. doi: 10.7759/cureus.41804. eCollection 2023 Jul.
Clostridium difficile (CD) is known to be pathogenic when the balance of intestinal microbiota is disrupted by the administration of broad-spectrum antimicrobial agents. Therefore, CD enteritis is often suspected in cases of hospital-onset diarrhea. There has been a rise in the incidence of community-acquired CD enteritis in recent years in the United States. In this report, we present a case of a 57 year-old-man who was admitted to the emergency department with abdominal distension and dyspnea. The patient suffered from acute renal failure and metabolic acidosis from enteritis. He required mechanical ventilation and continuous renal replacement therapy (CRRT) in the ICU. Analysis of the patient's stool sample on admission revealed the presence of CD antigens, and the prompt administration of metronidazole led to swift improvement. No studies have investigated the actual incidence of community-acquired CD enteritis infection in Japan. Since 20% of community-acquired CD enteritis cases have been reported as severe, all cases of community-acquired enteritis should raise concerns for CD enteritis. CD antigen/toxin in the stool should then be determined promptly before administering antibiotics.
艰难梭菌（CD）在肠道微生物群平衡因使用广谱抗菌药物而被破坏时具有致病性。因此，医院获得性腹泻病例常怀疑患有CD肠炎。近年来，美国社区获得性CD肠炎的发病率有所上升。在本报告中，我们介绍了一名57岁男性病例，该患者因腹胀和呼吸困难入住急诊科。患者因肠炎出现急性肾衰竭和代谢性酸中毒。他在重症监护病房需要机械通气和持续肾脏替代治疗（CRRT）。入院时对患者粪便样本的分析显示存在CD抗原，迅速给予甲硝唑后病情迅速改善。尚无研究调查日本社区获得性CD肠炎感染的实际发病率。由于20%的社区获得性CD肠炎病例被报告为重症，所有社区获得性肠炎病例都应引起对CD肠炎的关注。在使用抗生素之前，应立即测定粪便中的CD抗原/毒素。
