臨床検査57巻10号

2013年10月発行

今月の特集2 Clostridium difficile感染症

Clostridium difficile感染症の病院感染対策

著者： 大毛宏喜¹ 原稔典² 近藤美穂³ 末田泰二郎⁴

所属機関： ¹広島大学病院感染症科 ²広島大学病院診療支援部 ³広島大学病院看護部 ⁴広島大学大学院外科学

ページ範囲：P.1133 - P.1137

■便培養検査はClostridium difficile toxin検査と同時に提出するのが望ましい．

■院内伝播を防止するためにガウンや手袋を着用する．

■手指衛生は流水と石鹸による物理的な洗浄が一般的に推奨される．

参考文献

1）Pepin J, Valiquette L, Alary ME, et al：Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. cMAJ　171：466-472，2004

2）Warny M, Pepin J, Fang A, et al：Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet　366：1079-1084，2005

3）Ricciardi R, Rothenberger DA, Madoff RD, et al：Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg　142：624-631，2007

4）McFarland LV, Mulligan ME, Kwok RY, et al：Nosocomial acquisition of Clostridium difficile infection. N Engl J Med　320：204-210，1989

5）Shim JK, Johnson S, Samore MH, et al：Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet　351：633-636，1998

6）Aldeyab MA, Devine MJ, Flanagan P, et al：Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures. Infect Control Hosp Epidemiol　32：210-219，2011

7）Cohen SH, Gerding DN, Johnson S, et al：Clinical practice guidelines for Clostridium difficile infection in adults : 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol　31：431-455，2010

8）Okii K, Hiyama E, Takesue Y, et al：Molecular epidemiology of enteritis-causing methicillin-resistant Staphylococcus aureus. J Hosp Infect　62：37-43，2006

9）Sugiyama Y, Okii K, Murakami Y, et al：Changes in the agr locus affect enteritis caused by methicillin-resistant Staphylococcus aureus. J Clin Microbiol　47：1528-1535，2009

10）Johnson S, Gerding DN, Olson MM, et al：Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med　88：137-140，1990

11）Perry C, Marshall R, Jones E：Bacterial contamination of uniforms. J Hosp Infect　48：238-241，2001

12）Boyce JM, Ligi C, Kohan C, et al：Lack of association between the increased incidence of Clostridium difficile-associated disease and the increasing use of alcohol-based hand rubs. Infect Control Hosp Epidemiol　27：479-483，2006

13）Gopal Rao G, Jeanes A, Osman M, et al：Marketing hand hygiene in hospitals―a case study. J Hosp Infect　50：42-47，2002

14）Gordin FM, Schultz ME, Huber RA, et al：Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol　26：650-653，2005

15）Bettin K, Clabots C, Mathie P, et al：Effectiveness of liquid soap vs. chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol　15：697-702，1994

16）MMWR Recomm Rep：Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep　51：1-45，2002

17）Roberts K, Smith CF, Snelling AM, et al：Aerial dissemination of Clostridium difficile spores. BMC Infect Dis　8：7，2008