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难辨梭状芽孢杆菌(CD)相关性腹泻(CDAD)主要由应用广谱抗菌药物而引起,其发生率呈上升趋势。引起CDAD的常用药物有阿莫西林、克林霉素、林可霉素和头孢菌素类等。CDAD大多发生在应用抗菌药物治疗后5～10d。住院患者发生CDAD占抗菌药相关性腹泻(AAD)的15%～25%,病死率约为6%～30%。其发病机制为应用抗菌药后肠道正常菌群被抑制,使CD繁殖并产生毒素A(肠毒素)及毒素B(细胞毒素),引起肠黏膜损伤,上皮细胞变性、坏死和纤维素渗出而导致腹泻及其他症状。主要临床表现为腹泻(水样便)、发热、腹痛、结肠炎、伪膜性肠炎(PMC)、中毒性巨结肠、脓毒血症甚至死亡。老年、严重的基础疾病、长期住院、应用广谱抗菌药及免疫功能低下的患者是感染CD的危险因素。CDAD确诊后应停用可疑抗菌药物,可用甲硝唑或万古霉素等药物治疗。CDAD复发者可增加10～14d疗程甲硝唑或万古霉素治疗,多次复发者可应用考来烯胺、益生菌及人免疫球蛋白治疗。
Clostridium difficile (CD) -related diarrhea (CDAD) is mainly caused by the use of broad-spectrum antibiotics, and its incidence is on the rise. Common drugs that cause CDAD are amoxicillin, clindamycin, lincomycin and cephalosporins. CDAD occurred mostly in the application of antibacterial drugs after 5 ~ 10d. Inpatients CDAD accounted for 15% to 25% of antibacterial drug-associated diarrhea (AAD), the case fatality rate of about 6% to 30%. The pathogenesis of the use of antibacterial drugs after the normal intestinal flora is inhibited, the CD multiply and produce toxin A (enterotoxin) and toxin B (cytotoxic), causing intestinal mucosal injury, epithelial cell degeneration, necrosis and cellulose exudation And cause diarrhea and other symptoms. The main clinical manifestations of diarrhea (watery stool), fever, abdominal pain, colitis, pseudomembranous colitis (PMC), toxic megacolon, sepsis or even death. Elderly, serious underlying diseases, long-term hospitalization, the use of broad-spectrum antimicrobial agents and immunocompromised patients are risk factors for CD infection. CDAD suspects should be discontinued suspicious of antibiotics, available metronidazole or vancomycin and other drugs. CDAD recurrence can be increased 10 ~ 14d course of treatment of metronidazole or vancomycin, multiple relapse can be applied to test enamine, probiotics and human immunoglobulin therapy.