Relapse of antibiotic associated colitis: endogenous persistence of Clostridium difficile during vancomycin therapy.
Relapse of antibiotic associated colitis: endogenous persistence of Clostridium difficile during vancomycin therapy.
复制标题
抗生素相关性结肠炎复发：万古霉素治疗期间艰难梭菌的内源性持续存在。
作者：
B. Walters;R. Roberts;R. Stafford;E. Seneviratne
本研究报告了24例艰难梭菌引起的抗生素相关性结肠炎。由于结肠炎的严重程度，15名患者接受了万古霉素的治疗，其中8名患者在万古霉素治疗停止后出现结肠炎的临床复发。对这些患者的细菌学调查表明，在万古霉素治疗期间，在没有检测到细胞毒素的情况下，艰难梭菌能够在粪便样本中持续存在。这与7名成功接受万古霉素治疗而没有复发的患者和那些没有接受万古霉素治疗的患者形成了鲜明对比，这些患者的粪便培养和细胞毒素检测都呈阴性。这些结果提示，因艰难梭菌引起的抗生素相关性结肠炎而接受万古霉素治疗的患者，在治疗过程中和治疗后都应该进行粪便培养。在没有检测到细胞毒素的情况下，机体的持久性可能会识别那些复发并导致重新开始使用万古霉素或替代治疗方法的患者。
This study reports 24 patients with antibiotic associated colitis due to Clostridium difficile. Fifteen patients were treated with vancomycin due to the severity of the colitis and in eight of these a clinical relapse of the colitis occurred after vancomycin therapy was stopped. Bacteriological investigations of these patients indicated that C difficile was able to persist in stool samples during vancomycin therapy in the absence of detectable cytotoxin. This was in contrast with the seven patients successfully treated with vancomycin without relapse, and those not treated with vancomycin where both stool cultures and cytotoxin assays became negative. These results suggest that patients being treated with vancomycin for antibiotic associated colitis due to C difficile should have stool cultures done during and after treatment. Persistence of the organism in the absence of detectable cytotoxin may identify those patients who relapse and lead to either recommencement of vancomycin or alternative therapeutic approaches.