胃と腸43巻11号

2008年10月発行

今月の主題 感染性腸炎─最近の動向と知見 主題 感染性腸炎の最近の知見

Clostridium difficile感染症

著者： 松本主之¹ 藤澤律子¹ 河内修司¹ 平川克哉² 池上幸治² 平橋美奈子³ 飯田三雄¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²福岡赤十字病院消化器科 ³九州大学大学院医学研究院形態機能病理学

ページ範囲：P.1629 - P.1636

要旨　Clostridium difficile感染症の現状について最近の文献を中心に概説した．従来は偽膜性大腸炎の起炎菌として注目されてきたが，近年では無症候性保菌者を含めた院内感染の原因菌であること，集団発生が起こりうることなどから医療施設における感染制御の対象となっている．その病態は，① 単純性抗菌薬関連下痢症，② 非偽膜形成性下痢症，③ 偽膜性大腸炎，および ④ 劇症偽膜性大腸炎に至るまで多彩である．さらに，近年では炎症性腸疾患の増悪因子としても着目されている．偽膜性大腸炎は病歴と大腸内視鏡検査下の偽膜の確認で確定診断できるが，その他，病型の診断には組織培養ないし免疫法による便中毒素の証明が必要である．metronidazoleないしvancomycinの経口投与が第1選択の治療であり，難治例や再発例ではvancomycinの長期投与とプロバイオティクスや毒素吸着療法などを併用し，確実な治療を目指す必要がある．

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