What is the role of antimicrobial resistance in the new epidemic of Clostridium difficile?
What is the role of antimicrobial resistance in the new epidemic of Clostridium difficile?
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DOI：
10.1016/s0924-8579(09)70009-3
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发表时间：
2009-03-01
影响因子：
10.8
通讯作者：
Coia, John E.
中科院分区：
文献类型：
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作者：
Coia, John E.
近年来，艰难梭菌感染 (CDI) 的流行病学发生了变化，随着“高毒力”菌株（特别是 PCR 核糖型 027）的出现，出现了大规模感染暴发。对于导致 CDI 新流行的因素的性质，人们有很多猜测，并提出了各种假设。这些包括 CDI 风险人群规模的增加和/或其对感染的易感性的增加、与生物体的接触增加以及病原体毒力/传播性的变化。对一系列抗菌剂具有耐药性，包括。氟喹诺酮类药物是这些新出现菌株的共同特征。本文认为抗菌素耐药性可能是 CDI 流行病学变化的驱动因素，并提出了一个支持这种作用的模型。然而，人们承认缺乏明确的证据来证明 CDI 的因果作用以及 CDI 流行病学的复杂性。将抗菌药物耐药性视为相互作用改变“CDI方程”参数的一系列因素之一可能更准确，从而确定与任何给定的艰难梭菌新亚型相关的CDI问题的大小。 (C) 2009 Elsevier B.V. 和国际化疗协会。版权所有。
The epidemiology of Clostridium difficile infection (CDI) has changed in recent years, with the occurrence of large outbreaks of infection associated with the emergence of 'hypervirulent' strains, particularly PCR ribotype 027. There has been much speculation as to the nature of the factors responsible for driving the new epidemic of CDI, and various hypotheses have been proposed. These include increases in the size of the population at risk of CDI and/or their susceptibility to infection, increased exposure to the organism, and changes in the virulence/transmissibility of the pathogen. Resistance to a range of antimicrobial agents, including the. uoroquinolones, is a common feature of these newly emerged strains. This article considers the part antimicrobial resistance may play as a driver for the observed changes in the epidemiology of CDI and presents a model that would support such a role. However, the paucity of definitive evidence for a causal role and the complexity of the epidemiology of CDI are acknowledged. It may be more accurate to view antimicrobial resistance as one of a range of factors which interact to alter the parameters of the 'CDI equation', and thereby determine the size of the CDI problem associated with any given emerging subtype of C. difficile. (C) 2009 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.