Clostridium difficile -: Associated diarrhea
Clostridium difficile -: Associated diarrhea
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DOI：
10.1086/520276
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发表时间：
1998-05-01
影响因子：
11.8
通讯作者：
Gerding, DN
中科院分区：
文献类型：
--
作者：
Johnson, S;Gerding, DN
艰难梭菌（Clostridium difficile）被公认为是美国住院后患者感染性腹泻的主要原因，即使不是唯一的原因，也很可能是世界上发达国家的主要原因。难辨梭菌相关性腹泻（CDAD）发病与先前或同时进行的抗微生物治疗之间的时间关系引起了对该疾病发病机制的混淆，并导致人们认为这种感染与其他肠道腹泻综合征（如沙门氏菌病或志贺氏菌病）不同。具体来说，一些临床医生和感染控制从业人员的理解是，艰难梭菌是正常肠道菌群的一部分，数量很少，但由于抗菌剂抑制了其他肠道原生菌群，艰难梭菌随后会增殖或过度生长。我们目前对CDAD发病机制的理解是艰难梭菌，像几乎所有其他肠道病原体一样，是外源性获得的，感染后会出现各种临床结果，从无症状定植到腹泻，再到更严重的疾病综合征。这种肠道病原体的独特之处在于其重要的感染宿主（例如，医院和慢性病护理机构），以及它几乎完全依赖于肠道本地微生物群落提供的“感染耐药性”的事先破坏，这种破坏在给予抗菌素治疗时发生。
Clostridium difficile is well recognized as the major, if not the only, important cause of infectious diarrhea that develops in patients after hospitalization in the United States, and likely, in developed countries around the world [1]. The temporal relation between the onset of C. difficile-associated diarrhea (CDAD) and prior or concurrent antimicrobial therapy has caused confusion regarding the pathogenesis of this disease and has led to consideration of this infection as distinct from other enteric diarrhea syndromes such as salmonellosis or shigellosis. Specifically, the understanding of some clinicians and infection control practitioners is that C. difficile, which in small numbers is part of the normal intestinal flora, subsequently proliferates or overgrows because of suppression of the other indigenous bowel flora by antimicrobials. Our current understanding of the pathogenesis of CDAD is that C. difficile, like virtually all other enteric pathogens, is acquired exogenously and that a variety of clinical outcomes ensue following infection, ranging from asymptomatic colonization to diarrhea to more-severe disease syndromes. The unique aspects of this enteric pathogen are its important reservoirs of infection (eg, hospitals and chronic care facilities) and its nearly complete dependence on prior disruption of the" infection resistance" provided by the indigenous microflora of the intestine, which occurs when antimicrobial therapy is administered.