院内感染が示唆された泌尿器科病棟におけるClostridium difficile(C.difficile)下痢症の検討

Abstract

著者らの施設にある泌尿器科病棟において, Clostridium difficile下痢症が多発した.そこで, 臨床的検討と院内感染が疑われた病院内患者の検出菌から, 遺伝子型を応用した疫学的調査を行ない, 感染対策について考察した.C. difficile下痢症と診断したのは26名であり, 泌尿器科患者は男性8名, 女性3名であった.抗菌薬で多く使用されていたのはセフェム系であり, CTMが8例に投与されていた.PCR ribotypingの結果, C. difficile下痢症患者より, 単独分離に成功した17株のうち15株は同一パターンを示し, 少なくとも2種類の株が存在していることが確認された

Between June 2000 and January 2001, 11 patients were diagnosed with Clostridium diffcile (C. difficile)-associated diarrhea in the ward of urology at the Kakegawa Municipal Hospital. Of these 11 patients, 10 had exposure to antimicrobial agents, before the onset of diarrhea. All patients' stools were positive for C. difficile toxin A. After discotinuing antimicrobial agents with or without administering Vancomycin, they recovered from C. difficile-associated diarrhea. Between January 2001 and September 2002, 17 patients who were diagnosed with C. difficile-associated diarrhea in our hospital were classified into two types by PCR ribotyping. Therefore, we suspected a nosocomial outbreak of diarrhea caused by C. difficile.