Clinical recognition and diagnosis of Clostridium difficile infection
Clinical recognition and diagnosis of Clostridium difficile infection
复制标题
DOI：
10.1086/521863
复制
发表时间：
2008-01-15
影响因子：
11.8
通讯作者：
Gerding, Dale N.
中科院分区：
文献类型：
--
作者：
Bartlett, John G.;Gerding, Dale N.
及时和准确的诊断是有效管理艰难梭菌感染（CDI）的一个重要方面。CDI引起15%-25%的腹泻相关病例，其严重程度从轻度腹泻到暴发性假膜性结肠炎不等。在诊断CDI时应考虑几个因素，特别是高龄和住院治疗。特别是，在接受抗生素的患者中，入院后172小时发生的院内腹泻极有可能是由CDI引起的。检测粪便中是否存在C。艰难梭菌毒素证实了CDI的诊断。然而，酶免疫测定是确认CDI的常用方法，但与细胞毒性试验和粪便培养相比，该试验似乎相对不敏感。在选择性培养基上难以分离。内窥镜检查和计算机断层扫描比粪便毒素检测灵敏度低，但当即时结果很重要或其他混淆条件在鉴别诊断中排名较高时可能有用。这种诊断经常被忽视的方面是高白色血细胞计数（有时在类白血病范围内）和低白蛋白血症。
Prompt and precise diagnosis is an important aspect of effective management of Clostridium difficile infection (CDI). CDI causes 15%-25% of all cases of antibiotic-associated diarrhea, the severity of which ranges from mild diarrhea to fulminant pseudomembranous colitis. Several factors, especially advanced age and hospitalization, should be considered in the diagnosis of CDI. In particular, nosocomial diarrhea arising 172 hours after admission among patients receiving antibiotics is highly likely to have resulted from CDI. Testing of stool for the presence of C. difficile toxin confirms the diagnosis of CDI. However, performance of an enzyme immunoassay is the usual method by which CDI is confirmed, but this test appears to be relatively insensitive, compared with the cell cytotoxicity assay and stool culture for toxigenic C. difficile on selective medium. Endoscopy and computed tomography are less sensitive than stool toxin assays but may be useful when immediate results are important or other confounding conditions rank high in the differential diagnosis. Often overlooked aspects of this diagnosis are high white blood cell counts (which are sometimes in the leukemoid range) and hypoalbuminemia.