Cleary R K
St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA.
Dis Colon Rectum. 1998 Nov;41(11):1435-49. doi: 10.1007/BF02237064.
This review examines the pathogenesis, clinical manifestations, diagnosis, and current medical and operative strategies in the treatment of Clostridium difficile diarrhea and colitis. Prevention and future avenues of research are also investigated.
A review of the literature was conducted with the use of MEDLINE.
C. difficile is a gram-positive, spore-forming bacterium capable of causing toxigenic colitis in susceptible patients, usually those receiving antibiotics. Overgrowth of toxigenic strains may result in a spectrum of disease, including becoming an asymptomatic carrier, diarrhea, self-limited colitis, fulminant colitis, and toxic megacolon. Diagnosis requires a high index of suspicion and depends on clinical data, laboratory stool studies (enzyme-linked immunoabsorbent assay and cytotoxin test), and endoscopy in selected cases. Protocols for treatment of primary and relapsing infections are provided in algorithm format. Discontinuation of antibiotics may be enough to resolve symptoms. Medical management with oral metronidazole or vancomycin is the first-line therapy for those with symptomatic colitis. Teicoplanin, Saccharomyces spp. and Lactobacillus spp., and intravenous IgG antitoxin are reserved for more recalcitrant cases. Refractory or relapsing infections may require vancomycin given orally or other newer modalities. Fulminant colitis and toxic megacolon warrant subtotal colectomy. Cost, in terms of extended hospital stay, medical and surgical management, and, in some cases, ward closure, is thought to be formidable. Review of perioperative antibiotic policies and analysis of hospital formularies may contribute to prevention and decreased costs.
C. difficile diarrhea and colitis is a nosocomial infection that may result in significant morbidity, mortality, and medical costs. Standard laboratory studies and endoscopic evaluation assist in the diagnosis of clinically suspicious cases. Appropriate perioperative antibiotic dosing, narrowing the antibiotic spectrum when treating infections, and discontinuing antibiotics at appropriate intervals prevent toxic sequelae.
本综述探讨艰难梭菌性腹泻和结肠炎的发病机制、临床表现、诊断以及当前的药物和手术治疗策略。还研究了预防措施和未来的研究方向。
使用MEDLINE对文献进行综述。
艰难梭菌是一种革兰氏阳性、形成芽孢的细菌，能够在易感患者（通常是接受抗生素治疗的患者）中引起产毒性结肠炎。产毒菌株的过度生长可能导致一系列疾病，包括成为无症状携带者、腹泻、自限性结肠炎、暴发性结肠炎和中毒性巨结肠。诊断需要高度怀疑，并取决于临床数据、实验室粪便检查（酶联免疫吸附测定和细胞毒素试验）以及在特定病例中进行内镜检查。以算法形式提供了原发性和复发性感染的治疗方案。停用抗生素可能足以缓解症状。对于有症状性结肠炎的患者，口服甲硝唑或万古霉素进行药物治疗是一线疗法。替考拉宁、酿酒酵母属和乳酸杆菌属以及静脉注射免疫球蛋白抗毒素则用于更难治的病例。难治性或复发性感染可能需要口服万古霉素或其他更新的治疗方法。暴发性结肠炎和中毒性巨结肠需要行次全结肠切除术。就延长住院时间、药物和手术治疗以及在某些情况下关闭病房而言，成本被认为是巨大的。审查围手术期抗生素政策和分析医院处方集可能有助于预防和降低成本。
艰难梭菌性腹泻和结肠炎是一种医院感染，可能导致显著的发病率、死亡率和医疗费用。标准的实验室检查和内镜评估有助于诊断临床可疑病例。适当的围手术期抗生素给药、在治疗感染时缩小抗生素谱以及在适当的间隔停用抗生素可预防毒性后遗症。
