Antibiotic-associated diarrhoea and Clostridium difficile in the community
Antibiotic-associated diarrhoea and Clostridium difficile in the community
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DOI：
10.1046/j.1365-2036.2003.01531.x
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发表时间：
2003-04-01
影响因子：
7.6
通讯作者：
Petit, JC
中科院分区：
文献类型：
--
作者：
Beaugerie, L;Flahault, A;Petit, JC
背景：艰难梭菌是医院感染性腹泻的主要原因，也是结肠炎的病原体。C的参与。difficile感染在astictic相关的腹泻在community.Methods：我们前瞻性研究了266例成人门诊病人在巴黎（法国）地区谁规定了5-10天的疗程抗菌化疗。粪便进行C.通过标准培养、产毒培养和毒素B的细胞病变效应测试，在治疗开始前和治疗开始后14天检测艰难梭菌。要求患者记录每日大便频率和稠度。腹泻被定义为通过至少三个松散的粪便，每天。结果：46（17.5%）的262评估患者在研究期间腹泻。所有患者的腹泻均为轻度和自限性，65.6%的病例仅持续1天。C.在治疗前后从一名未发生腹泻的患者中分离出艰难梭菌。C.仅在10例患者（3.8%）的第14天检测到艰难梭菌。分离株在7名患者中产生毒素。这7例患者中有4例出现轻度自限性腹泻。产毒素C.有腹泻史的患者中艰难梭菌的检出率明显高于无腹泻史的患者（8.7%比1.4%，P = 0.02）。艰难梭菌似乎在社区抗菌化疗期间很常见[估计发生率为2700（1150-5400）例/100 000次抗生素暴露]。然而，C. difficile不是门诊患者中轻度腹泻相关腹泻的主要病原体。
Background: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic-associated colitis. The involvement of C. difficile infection in antibiotic-associated diarrhoea in the community is poorly documented.Methods: We studied prospectively 266 adult out-patients in the Paris (France) area who were prescribed a 5-10-day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day.Results: Forty-six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self-limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self-limited diarrhoea. Toxin-producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P = 0.02).Conclusion: The acquisition of toxin-producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150-5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic-associated diarrhoea in out-patients.