Aronsson B, Möllby R, Nord C E
J Antimicrob Chemother. 1984 Dec;14 Suppl D:85-95. doi: 10.1093/jac/14.suppl_d.85.
Experience of the diagnosis and epidemiology of Clostridium difficile in Sweden is reviewed. Samples from 5885 patients have been investigated at the National Bacteriological Laboratory in Stockholm from 1978-1983. Patients originate from all parts of the country and their number continues to increase. Cl. difficile seem to be of growing importance, especially in nosocomial infections. Most patients with antibiotic-associated diarrhoea and colitis (AAD/AAC) and Cl. difficile in their stools were above 60 years of age (63%) and there was a significant preponderance of females over males in the age groups 21-50 and above 60 years of age. The antibiotics most commonly associated with Cl. difficile enterocolitis (CDE) were penicillins, cephalosporins and clindamycin/lincomycin. On the basis of consumption clindamycin/lincomycin and cephalosporins are associated 70 and 40 times, respectively, more often than penicillins in CDE. Diagnosis of CDE relies mainly on detection of the cytotoxin (toxin B) in stool specimens. It was present in 873/4793 (18.2%) patients whereas the bacterium was found in only 12%. An immunoassay for detection of the enterotoxin (toxin A) of Cl. difficile seems to be a useful alternative to the cytotoxin assay, but some stool specimens with a low toxin B titre were negative. Five specimens negative for toxin B were positive for toxin A and came from patients where additional information suggested CDE. A serological assay for demonstration of circulating antibodies to Cl. difficile toxins has also been evaluated and is positive in about half of the cases of CDE. Antibody response seems to be absent or delayed in patients with relapse of colitis after antibiotic treatment.
本文回顾了瑞典艰难梭菌的诊断和流行病学经验。1978年至1983年期间，斯德哥尔摩国家细菌学实验室对5885名患者的样本进行了调查。患者来自瑞典全国各地，且数量持续增加。艰难梭菌的重要性似乎日益凸显，尤其是在医院感染方面。大多数患有抗生素相关性腹泻和结肠炎（AAD/AAC）且粪便中存在艰难梭菌的患者年龄在60岁以上（63%），在21至50岁以及60岁以上年龄组中，女性明显多于男性。与艰难梭菌性小肠结肠炎（CDE）最常相关的抗生素是青霉素、头孢菌素和克林霉素/林可霉素。基于药物使用情况，在CDE中，克林霉素/林可霉素和头孢菌素与CDE的关联频率分别比青霉素高70倍和40倍。CDE的诊断主要依赖于粪便标本中细胞毒素（毒素B）的检测。在4793名患者中有873名（18.2%）检测到细胞毒素，而仅12%的患者检测到该细菌。一种用于检测艰难梭菌肠毒素（毒素A）的免疫测定法似乎是细胞毒素测定法的有用替代方法，但一些毒素B滴度较低的粪便标本检测结果为阴性。5份毒素B检测阴性的标本毒素A检测呈阳性，这些标本来自其他信息提示患有CDE的患者。一种用于检测针对艰难梭菌毒素的循环抗体的血清学测定法也已得到评估，在大约一半的CDE病例中呈阳性。抗生素治疗后结肠炎复发的患者似乎没有抗体反应或抗体反应延迟。
