C. difficile 감염 진단과 치료의 최신 지견

1 Essentials of Primary Care: . C. difficile : .. Clostridium difficile .. 2000 ,000 2008 ,000 . , , 1991 ,000 .. 2-17 m 2003 ,000 .. 1 C. difficile . Bacillus difficilis , C. sordellii 1999 793 2008 7483 . C. difficile 65 .. , C. difficile . C. difficile 2004 ,000 2008 ,000 . , A B . 2009 .. ,000 NAP1/027 .. NAP1/027.. - C. difficile . , .. 1 gram 108 C. difficile . C. difficile . Clin- C. difficile damycin, cephalosporin , . NAP1/027 fluoroquinolone . A , B .. , , . Rho , , .. C. difficile , . binary toxin , NAP1/027 (proton pump inhibitor) . binary toxin A B .. binary toxin .. C. difficile .. 5-10 . C. difficile 2003 NAP1/027 1 , 10 . - 157 - 2016 .. (30-50%), . (50-60%), (20-33%) , . 2-10 mm , , , , , . , .. , , (plaque) .. , , . 90% C. difficile . , , .. 10% .. , , , . , .. C. difficile . Pathology . , 1.

2 , C. difficile . , .. , ( ) ( ).. , glutamate dehydrogenase . ( ) ( ) .. , 2 . 72 C. difficile , .. 20% .. C. difficile .. metronidazole gold standard C. difficile metronidazole , , (2 ), 500 mg 3 10-14 .. metronidazole C. difficile . , C. difficile . , , metronidazole 90% g/mL .. metronidazole .. A , . B . metronidazole .. C. difficile . metronidazole . C. difficile . , .. - 158 - . C. difficile : . vancomycin . FDA , C. difficile . vancomycin 125 mg 4 10-14 .. vancomycin , . , , . 1,000-3,000 g/mL . C. difficile . 5-50% .. Metronidazole .. 1 . (Metronidazole 37 /250 mg * 2 * tid * 10 2,220 vs. , 2 vancomycin . vancomycin 4,524 /250 mg * 1/2 * qid * 10 90,480 ).. Vancomycin 14 . vancomycin . C. difficile metronidazole . Saccharomyces , boulardii , , . metronidazole .. metronidazole . Vancomycin . vancomycin.

3 , vancomycin 500 mg 4-8 . (retention enema) . C. difficile , .. (hypochlorite) . Nitazoxanide, rifaximin, tigecycline, bacitracin, fusidic acid, . IDSA SHEA . teicoplanin , ( ), 1 .. , OPT-80, difimicin, PAR-101 , , , . fidaxomicin , 2012 . C. difficile (clindamycin, fluoroquinolone ) .. Fidaxomicin 200 mg 2 10 . vancomycin 125 mg 4 10 . 3 , fidaxomicin . vancomycin REFERENCES. , . 1. Mandell, Douglas, and Bennett's Principles and practice of . Infectious Disease. 2. Stuart H. Cohen, 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 Disease Society of America (IDSA).. Infect Control Hosp Epidemiol 2010;31:431-455. , 3. Clinical Infectious Disease 2012;55(S2):s65-s169. 30-35% C. difficile 4.

4 Clinical Infectious Disease 2008;46(S1):s1-s52. - 159.