Clostridioides（Clostridium）difficile感染症 診療ガイドラ …

1 clostridioides clostridium difficile Vol. 66 No. 6 645 C. difficile I clostridioides clostridium difficile 651II GDH nucleic acid amplification test NAAT 655 CDI 658 CDI NAAT 662 B CDI 667 CDI 671 675 CDI 677 CDI C. difficile 680 CDI 683 fecal microbiota transplantation FMT 685 CDI Antimicrobial stewardship 689 Vol.

2 66 No. 6 clostridioides clostridium difficile 647C. difficile C. difficile CDI GDH C. difficile NAAT NAAT GDH 1 C. difficile 1 GDH NAAT GDH GDH CDI GDH CDI GDH GDH NAAT CDI CDI C. difficile GDH Bristol score 5 NAAT CDI CDI CDIGDH GDH GDH CDI Vol.

3 66 No. 6 clostridioides clostridium difficile 6482 C. difficile 2a, 2b GDH NAAT NAAT NAAT 2a GDH NAAT 2b Bristol score 5 GDH CDICDI GDH GDH CDI GDH NAAT CDI CDI CDI Bristol score 5 GDH NAAT GDH NAAT CDI CDI GDH CDI GDH CDICDI CDI ab Vol. 66 No. 6 clostridioides clostridium difficile 649C. difficile CDI or or or or or or B CDI ( 027 078 244) 3 +/ +/ +/ +/ 2 Vol.

4 66 No. 6 clostridioides clostridium difficile 650I clostridioides clostridium difficile clostridioides clostridium difficile clostridioides clostridium infection CDI C. difficile C. difficile C. difficile B C. difficile C. difficile C. difficile C. difficile C. difficile C. difficile COI COI COI COI clostridioides Clostrid-ium difficile COI 1 2 3 MSD MSD MSD MSD Meiji Seika Vol.

5 66 No. 6 651 MSD MSD Meiji Seika MSD MSD Meiji Seika MSD MSD MSD Meiji Seika

6 CDI Vol. 66 No. 6 clostridioides clostridium difficile 652 / clostridium difficile clostridioides clostridium difficile clostridioides clostridium difficile The Japanese Clinical Practice Guidelines for Management of clostridioides (Clostrid-ium) difficile infections C.

7 Difficile C. difficile C. difficile C. difficile C. difficile C. difficile C. difficile C. difficile 1 C. difficile 2 C. difficile 3 C. difficile 4 C. difficile 5 C. difficile 6 C. difficile 7 C. difficile 8 C. difficile Vol. 66 No. 6 clostridioides clostridium difficile 653 9 C. difficile 10 C. difficile 1 SR MA 2 Medline SR/MA Medline The Cochrane Library Guideline International Network International Guide-line Library AHRQ National Guideline Clearinghouse 3 PICO 4 2000 2018 6 Vol.

8 66 No. 6 clostridioides clostridium difficile 654II CQ GDH nucleic acid amplification test NAAT GDH NAAT NAAT 1 CQ GDH GDH C. difficile CDI 2 PICO P CDI GDH I NAAT C NAAT GDH O C. difficile 3 GDH NAAT 1 Planche GDH NAAT 2 GDH NAAT GDH NAAT 2 GDH NAAT 91 98% 96 98% vs GDH 58 84% 99% vs NAAT 59 85% 99% 1 Walkty 2 GDH NAAT 3 70% 100% vs GDH 41% 100% vs GDH NAAT 68% 100% 2 13 NAAT 40 93% 97 100% NAAT 68 100% 92 100% 3 GDH EIA 65 150 150 NAAT

9 NAAT CDI NAAT vs 4 Vol. 66 No. 6 clostridioides clostridium difficile 6554 A 5 GDH NAAT 6 7 NAAT 8 9 NAAT 10 NAAT 11 12 IDSA/SHEA 2017 IDSA 2017 ESCMID update 2016 American College of Gastroenterology 2013 1. Planche 1 N 10,634 GDH TC /CCA 58 84 >9959 81 99 GDH NAATTC/CCA 91 98 96 98 90 92 96 99 NAATTC/CCA 59 85 9990 93 96 Walkty 2 N 428 GDH TC4110010091 GDH NAATTC6810010095 GDH NAATTC7010010095 toxigenic culture cell cytotoxic assay Vol.

10 66 No. 6 clostridioides clostridium difficile 656 1 Planche T D, Davies K A, Coen P G, Finney J M, Monahan I M, Morris K A, et al Differences in outcome according to clostridium difficile testing method a prospective multicentre diagnostic validation study of C difficile infection. Lancet Infect Dis 2013 13 936-45 2 Walkty A, Lagac -Wiens P R, Manickam K, Adam H, Pieroni P, Hoban D, et al Evaluation of an algorithmic approach in comparison with the Illumigene assay for laboratory diagno-sis of clostridium difficile infection. J Clin Microbiol 2013 51 1152-7 3 Bagdasarian N, Rao K, Malani P N Diagnosis and treatment of clostridium difficile in adults a systematic review. JAMA 2015 313 398-408 4 Swindells J, Brenwald N, Reading N, Oppenheim B Evaluation of diagnostic tests for Clos-tridium difficile infection.