Clostridium difficile infection: a review of current and emerging therapies.
Clostridium difficile infection: a review of current and emerging therapies.
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DOI：
10.20524/aog.2016.0006
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发表时间：
2016-04
影响因子：
2.2
通讯作者：
Ofosu A
中科院分区：
文献类型：
--
作者：
Ofosu A
艰难梭菌（C.艰难梭菌感染（CDI）是美国医院医疗保健相关感染的最常见原因。流行株NAP 1/BI/ribotype 027在世界范围内爆发，死亡率和严重程度不断增加。CDI是从内源性来源或环境中的孢子获得的，最容易在住院期间获得。抗菌药物的使用破坏了肠道微生物菌群，使C。难以在结肠中增殖并产生毒素。有症状患者的临床诊断需要从粪便标本中进行毒素检测，很少与粪便培养结合以提高灵敏度。然而，粪便培养对流行病学研究至关重要。口服甲硝唑是轻度CDI病例的推荐治疗，口服万古霉素或非达霉素用于更严重的病例。首次复发的治疗包括使用与初始CDI相同的治疗。在第二次复发的情况下，口服万古霉素通常以逐渐减少的剂量或间歇性地给药，或者可以使用非达霉素。粪便移植在复发性CDI的治疗中发挥着巨大的作用，效果显著。爆发性结肠炎和中毒性巨结肠需要手术干预。包括新抗生素和针对CDI或其毒素的免疫疗法在内的新方法似乎具有潜在价值。
Clostridium difficile (C. difficile) infection (CDI) is the most common cause of healthcare-associated infections in US hospitals. The epidemic strain NAP1/BI/ribotype 027 accounts for outbreaks worldwide, with increasing mortality and severity. CDI is acquired from an endogenous source or from spores in the environment, most easily acquired during the hospital stay. The use of antimicrobials disrupts the intestinal microflora enabling C. difficile to proliferate in the colon and produce toxins. Clinical diagnosis in symptomatic patients requires toxin detection from stool specimens and rarely in combination with stool culture to increase sensitivity. However, stool culture is essential for epidemiological studies. Oral metronidazole is the recommended therapy for milder cases of CDI and oral vancomycin or fidaxomicin for more severe cases. Treatment of first recurrence involves the use of the same therapy used in the initial CDI. In the event of a second recurrence oral vancomycin often given in a tapered dose or intermittently, or fidaxomicin may be used. Fecal transplantation is playing an immense role in therapy of recurrent CDI with remarkable results. Fulminant colitis and toxic megacolon warrant surgical intervention. Novel approaches including new antibiotics and immunotherapy against CDI or its toxins appear to be of potential value.