Diagnostic role of stool culture & toxin detection in antibiotic associated diarrhoea due to Clostridium difficile in children.
Diagnostic role of stool culture & toxin detection in antibiotic associated diarrhoea due to Clostridium difficile in children.
复制标题
粪便培养的诊断作用
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
Kulkarni Mv
中科院分区：
文献类型：
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作者：
A. Gogate;A. De;R. Nanivadekar;M. Mathur;K. Saraswathi;A. Jog;Kulkarni Mv
背景与目的
单纯培养诊断艰难梭菌对诊断C.很难毒素A和B的检测是诊断由C引起的AAD的主要方法。很难本研究旨在探讨粪便培养和毒素检测在诊断C.很难由于印度关于C.在5-12岁年龄组的儿童中，选择该年龄组。
方法
从250名5-12岁年龄组的住院儿童中收集粪便样本，这些儿童因不同的医疗问题接受抗生素治疗超过5天而发生腹泻。还收集了250名年龄和性别匹配的对照的粪便样品。培养C.在环丝氨酸头孢西丁果糖蛋黄琼脂（CCFA）上进行艰难梭菌的克隆，并通过标准实验室技术鉴定菌落。ELISA检测毒素A和B，组织培养检测毒素B。
结果
与对照组相比，该研究组的总体阳性率为18%（P<0.001）。5-8岁年龄组阳性率最高（84.4%）。严重腹泻、带粘液和血液的液体粪便、粪便白细胞>5/高倍视野、改变的植物群和革兰氏染色上存在具有椭圆形近端孢子的革兰氏阳性杆菌是诊断由C.很难在阳性病例中，68.9%对停用抗生素有反应，31.1%对甲硝唑治疗有反应。
解释和结论
C.艰难梭菌是引起5-12岁儿童抗生素相关性腹泻（antibiotic associated diarrhea，AAD）的重要病原菌。抗生素的保守使用有利于降低AAD的发生率。
BACKGROUND & OBJECTIVE
Mere diagnosis of Clostridium difficile by culture does not help in the diagnosis of antibiotic associated diarrhoeae (AAD) due to C. difficile. Detection of toxins A and B form the mainstay in the diagnosis of AAD due to C. difficile. This study was undertaken to find out the role of stool culture and toxin detection in the diagnosis of AAD due to C. difficile. As there are very few documented reports from India about AAD due to C. difficile in children in the age group of 5-12 yr, this age group was selected.
METHODS
Faecal samples were collected from 250 hospitalized children in the age group of 5-12 yr who developed diarrhoea on receiving antibiotics for different medical problems for more than five days duration. Also faecal samples of 250 age and sex matched controls were collected. Culture for C. difficile was done on cycloserine cefoxitin fructose egg yolk agar (CCFA) and colonies were identified by standard laboratory techniques. ELISA for toxins A and B detection and tissue culture on HeLa cells for toxin B detection were also done.
RESULTS
Overall positivity was 18 per cent in this study group compared to the controls (P<0.001). Maximum positive cases were in 5-8 yr age group (84.4%). Severe diarrhoea, liquid stool with mucus and blood, faecal leucocytes >5/high power field, altered flora and presence of Gram-positive bacilli with oval subterminal spores on Gram stain were sensitive predictors for diagnosis of AAD due to C. difficile. Amongst positive cases, 68.9 per cent responded to discontinuation of antibiotics and 31.1 per cent to metronidazole therapy.
INTERPRETATION & CONCLUSION
C. difficile was an important pathogen responsible for antibiotic associated diarrhoea (AAD) in children of 5-12 yr age group. Conservative use of antibiotics would be beneficial to decrease the incidence of AAD.