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11.
《Journal of microbiology, immunology, and infection》2019,52(6):841-850
Clostridium difficile infection (CDI) remains a major public health issue, and fecal microbiota transplantation (FMT) has become one of the standard therapies for recurrent or refractory CDI. When compared to medical therapies, such as metronidazole or vancomycin, FMT has a high rate of treatment response with acceptable safety and efficiency. Following promulgation of the amendments in September 2018 in Taiwan, FMT has been indicated for recurrent or refractory CDI. The Taiwan Microbiota Consortium contributed to the Taiwan FMT Expert Consensus, which established basic norms and stipulated essential principles, including the indications for transplantation, eligible locations and personnel, donor screening policies, fecal sample handling, and post-FMT follow-up. However, establishing an eligible FMT team in a qualified hospital remains a clinical challenge, and the requirement for facilities and well-screened donors impedes the implementation of FMT. In this review, we aim to provide domestic FMT teams with explicit instructions to facilitate realization and increase the practice of FMT. Based on the Taiwan FMT Expert Consensus and current regulations, we performed a literature review and integrated the experiences of Taiwanese multidisciplinary experts into this article. The content intends to offer clinicians up-to-date evidence and highlight the essential points of FMT. 相似文献
12.
Bo Aronsson Marta Granstrm Roland Mllby Carl Erik Nord 《Journal of immunological methods》1983,60(3):341-350
Enzyme-linked immunosorbent assay (ELISA) was established with purified toxins from Clostridium difficile as antigene to measure antibody response in patiensts with pseudomembranous colitis (PMC) and prolonged antibiotic-associated diarrhoea (AAD). Positive ELISA titres were defined in a control population. Antibodies of IgG class against toxin B were demonstrated in 6/88 (7%) control sera and in 31/61 (51%) sera from 11/19 (58%) patients. Antibodies of IgA class were found in one patient while antibodies of IgM class were not demonstrated. ELISA antibodies against toxin A were not demonstrated. For comparison a neutralization test was performed and neutralizing antibodies to toxin B but not to toxin A were demonstrated in 10/61 (16%) sera from 4/19 (21%) patients and in none of the controls. ELISA was found to be a more sensitive assay than neutralization. ELISA antibodies were detected from the third week of the disease while neutralizing antibodies appeared after 5 weeks. Lack of an antibody response in ELISA seemed to correlate to a more severe colitis. 相似文献
13.
Frédéric Barbut Muriel Macé Valérie Lalande Patrick Tilleul Jean-Claude Petit 《Clinical microbiology and infection》1997,3(4):480-483
Objective: To evaluate a rapid (15-min) enzyme immunoassay in the format of an individual cassette (ImmunoCard toxin A, Meridian, BMD, Marne-la-Vallée, France) for the detection of Clostridium difficile toxin A in stool specimens.
Methods: We compared this new test with the cytotoxicity assay using MRC-5 cells, the ToxA test (TechLab, BioWhittaker, Fontenay-sous-bois, France) and toxigenic culture for the diagnosis of C. difficile -associated diseases (CDAD). A total of 236 stool specimens collected from 220 patients was simultaneously tested with the four methods. Discordant results were resolved by reviewing patients' clinical records.
Results: The prevalence of CDAD was 13.9%. Test sensitivities and specificities were 100% and 99% respectively for the cytotoxicity assay, 87.5% and 100% for ImmunoCard toxin A, 77.4% and 100% for the ToxA test and 100% and 98% for toxigenic culture.
Conclusions: The ImmunoCard Toxin A is a very rapid, individual and easy-to-perform test for the diagnosis of CDAD. It provides same-day results and may be useful for both guiding appropriate treatment and controlling nosocomial spread of C. difficile. 相似文献
Methods: We compared this new test with the cytotoxicity assay using MRC-5 cells, the ToxA test (TechLab, BioWhittaker, Fontenay-sous-bois, France) and toxigenic culture for the diagnosis of C. difficile -associated diseases (CDAD). A total of 236 stool specimens collected from 220 patients was simultaneously tested with the four methods. Discordant results were resolved by reviewing patients' clinical records.
Results: The prevalence of CDAD was 13.9%. Test sensitivities and specificities were 100% and 99% respectively for the cytotoxicity assay, 87.5% and 100% for ImmunoCard toxin A, 77.4% and 100% for the ToxA test and 100% and 98% for toxigenic culture.
Conclusions: The ImmunoCard Toxin A is a very rapid, individual and easy-to-perform test for the diagnosis of CDAD. It provides same-day results and may be useful for both guiding appropriate treatment and controlling nosocomial spread of C. difficile. 相似文献
14.
目的:了解住院老年病人难辨梭菌小区域暴发流行的情况。方法:对我院神经内科一起暴发流行难辨梭状芽胞杆菌相关性腹泻(CDAD)的5例老年患者进行回顾调查。结果5例难辨梭状芽胞杆菌相关性腹泻的病人占同期神经内科住院病人的3.57%(5/140);其中轻型1例,重型1例,暴发型3例;痊愈3例,死亡2例。结论:①老年住院患者、抗生素使用及严重的基础疾病、气管切开和胃管进食是导致难辨梭菌感染的高危因素。②区域性丛集分布的患病人群提示有外源性交叉感染的可能。③暴发型难辨梭状芽胞杆菌感染病情进展迅猛,并发症严重,预后极差。 相似文献
15.
Emmanuel Nwachuku Yizhi Shan Prabhu Senthil-Kumar Todd Braun Ryan Shadis Orlando kirton Thai Q. Vu 《American journal of surgery》2021,221(1):240-242
BackgroundClostridioides difficile infection (CDI) is traditionally taught to be an antibiotic associated diarrheal infection. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 h) coupled with a diagnostic test. There is now a new presentation of CDI, including progression to toxic megacolon, in patients without diarrhea.MethodsWe report a case series of 9 surgical patients from a single institution who developed CDI without preceding diarrhea.ResultAll 9 patients had CDI with positive laboratory testing for C. difficile toxin. They, however, presented with a lack of or minimal bowel movements. Six patients had rapid development of abdominal distention, 1 patient had a single episode of watery stool in 3 days, while the other 2 patients presented with constipation. Seven patients received stool softeners, suppositories and/or enemas for presumed constipation. Four patients had a mild course of infection and were successfully treated medically. The other 5 patients developed toxic megacolon, and eventually required total abdominal colectomy. Out of the 5 patients that required total colectomy, 2 expired.ConclusionCDI must be suspected in patients who rapidly develop abdominal distention, vague abdominal complaints or change in bowel function even in the absence of diarrhea, especially if coupled with multi-system organ failure. 相似文献
16.
17.
Clostridium perfringens is a normal bacterial flora of the small and large intestines of humans and other animals. The current study investigates the potential use of a noncytotoxic C. perfringens as an oral vaccine vehicle for expression and intestinal delivery of a large amount of SIV antigens. Here we report the construction of a recombinant C. perfringens vaccine vector expressing high levels of SIV p27 during sporulation. Following oral administration of this recombinant C. perfringens vaccine vector to mice, large amounts of intact p27 protein were detected in the terminal ileum where the majority of Peyer's Patches (PPs) are located. Furthermore, dendritic cells (DCs) beneath the mucosal surface in the PPs were able to capture SIV p27 antigen, when PPs were exposed to C. perfringens expressing SIV p27 antigen. In addition, uptake of C. perfringens was able to induce maturation of mouse DCs. These results support the potential use of C. perfringens as an oral SIV/HIV vaccine vector. 相似文献
18.
抗脆弱类杆菌和产气荚膜杆菌McAb池在外科感染快速诊断中的应用 总被引:2,自引:0,他引:2
目的 制备抗脆弱杆菌和抗产气荚膜杆菌单克隆抗体池,并用于快速诊断及时指导临床治疗。方法 采用间接免疫荧光抗体染色法(IFA)和免疫酶标抗体染色法(ELA)对我院1998~1999年191例外科感染患者的标本进行细菌学检测,并与常规培养法进行比较。结果 3种方法从191份标本中分别检出脆弱类杆菌53株(27.7%)和55株(28.8%)以及25株(13.1%);检出产气荚膜杆菌12株(6.3%)和11株(5.8%)以及6株(3.1%)。IFA和ELA法2种厌氧菌检出率明显高于CM法。但IFA和ELA法之间检出率差异无显著性。结论 自制脆弱类杆菌和抗产气荚膜杆菌的McAb池,检测平时常见的脆弱类杆菌和战时常见的产气荚膜杆菌,敏感性高,简便,快速、便于推广。 相似文献
19.
Patterns and prognosis ofClostridium difficile colitis 总被引:2,自引:2,他引:0
Boyd C. Marts M.D. Ph.D. Walter E. Longo M.D. Anthony M. Vernava III M.D. Donald J. Kennedy M.D. Gayle L. Daniel R.N. B.S.N. Ivy Jones R.N. 《Diseases of the colon and rectum》1994,37(8):837-845
The incidence of
Clostridium difficile
colitis has increased during recent years, presumably because of liberal use of broad-spectrum antibiotic regimens. METHODS: A retrospective review to determine patterns of
C. difficile
colitis development, morbidity, and treatment results was undertaken. During an 18-month period, 90 patients were diagnosed with
C. difficile
colitis by fecal toxin assays. Patient demographics, symptoms, previously administered antibiotic regimens, diagnostic evaluations, treatment modalities, morbidity, and mortality were identified, entered into a computer data base, and analyzed. RESULTS: The mean age was 58 years; males outnumbered females 1.21. Among 90 patients, 41 (46 percent) developed
C. difficile
colitis after surgical procedures. Eighty (89 percent) patients received antibiotic therapy before developing
C. difficile
colitis: 35 (44 percent) for documented infections and 45 (56 percent) as empiric or prophylactic therapy. Cephalosporins, penicillins, quinolones, vancomycin, and aminoglycosides were the most frequently administered antibiotic classes prior to
C. difficile
colitis diagnosis. Ten (11 percent) patients developed
C. difficile
colitis without previous antibiotic therapy. Eighty-two (91 percent) patients presented with diarrhea, while eight (9 percent) had fever only. Primary
C. difficile
colitis treatment for both groups included vancomycin (66 percent), metronidazole (24 percent), or both drugs (10 percent). Ten (11 percent) patients received no treatment. No patient developed toxic colitis or megacolon. Colonoscopy was performed in four (4 percent) patients; pseudomembranes were identified in one (25 percent) patient. There was one
C. difficile
colitis recurrence after treatment, but no
C. difficile
colitis-associated morbidity. Mortality (14 patients, 16 percent) was not related to
C. difficile
colitis, but to underlying illness. No difference in patient age, sex, previous antibiotic administration, serum albumin, total days hospitalized, duration of
C. difficile
colitis antibiotic therapy,C. difficile
colitis treatment regimens, or mortality was identified between nonsurgical and surgical patients. The white blood cell count was significantly lower in the nonsurgical group however.Clostridium difficile
colitis developed most commonly after antibiotic administration with symptoms of diarrhea, but did occur without previous antibiotic administration or diarrhea. CONCLUSION: Despite the clinical setting,C. difficile
colitis had no associated morbidity and treatment was highly effective. Mortality was related to underlying medical illness, not
C. difficile
colitis.Read at the meeting of The American Society of Colon and Rectal Surgery, Chicago, Illinois, May 2 to 7, 1993. 相似文献
20.
Clostridium difficile colitis in the critically Ill 总被引:1,自引:1,他引:0
S. Grundfest-Broniatowski M.D. M. Quader M.D. F. Alexander M.D. R. M. Walsh M.D. I. Lavery M.D. J. Milsom M.D. 《Diseases of the colon and rectum》1996,39(6):619-623
Morbidity and treatment of
Clostridium difficile
colitis (CDC) continue to be controversial. Some claim minimum morbidity, which may be a function of differences in patient population and/or bacterial virulence. METHODS: To evaluate the effect of CDC in the critically ill, we retrospectively reviewed the records of 59 intensive care unit patients with CDC who were diagnosed by fecal toxin assays or clinical evidence of pseudomembranous colitis from January 1991 to October 1994. Symptoms, signs, antibiotic regimens, diagnostic tests, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, morbidity, and mortality were analyzed, and results of surgical treatment were compared with the literature. RESULTS: Mean age was 66.4 (17–95) years, with a male to female ratio of 1.81. First treatment was metronidazole by mouth in 15 patients (25.4 percent), vancomycin by mouth in 30 patients (50.8 percent), sequential by mouth vancomycin/metronidazole in 3 patients (5.1 percent), and intravenous metronidazole in 5 patients (8.5 percent). Six patients had no medical therapy before surgery or discharge. Ten patients (17 percent) had recurrence and 12 (20.3 percent) required surgery for progressive toxicity or peritonitis. Of three patients who were initially treated by diverting stomas, one died and two required total colectomy (TAC). Two underwent partial resection (1 that was nearly a total colectomy), and seven others had a TAC. Surgical patients had worse mean APACHE II scores at diagnosis (24.4
vs.
199;P<0.001). Thirty-day mortality in surgical patients was 41.7
vs.
14.7 percent in medical patients (P<0.5).CONLUSION: Twenty percent of critically ill patients with CDC required operation. TAC and diversion appeared to be more effective surgical treatments than diversion alone.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995. 相似文献