Clostridium difficile and inflammatory bowel disease: Role in pathogenesis and implications in treatment
Clostridium difficile and inflammatory bowel disease: Role in pathogenesis and implications in treatment
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DOI：
10.3748/wjg.v19.i43.7577
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发表时间：
2013-11-21
影响因子：
4.3
通讯作者：
Saliba, Walid
中科院分区：
文献类型：
--
作者：
Nitzan, Orna;Elias, Mazen;Saliba, Walid
艰难梭菌（C. difficile）是抗生素相关性结肠炎和院内腹泻的主要原因。炎症性肠病（IBD）患者发生艰难梭菌感染（CDI）的风险增加，CDI的预后较差，包括更高的结肠切除术和死亡率，以及更高的复发率。然而，尚不清楚艰难梭菌是IBD的病因还是肠道环境炎症状态的结果。在过去十年中，CDI的负担急剧增加，许多国家都发生了严重的疫情，这些疫情被归因于一种新的、毒性更强的菌株。在IBD患者中，CDI的发生率也出现了平行上升。伴有CDI的IBD患者往往更年轻，既往抗生素暴露较少，这些患者中的大多数CDI病例代表门诊获得性感染。这些患者的CDI临床表现可能是独特的，包括分流性结肠炎、肠炎和囊炎，结肠镜检查通常没有典型的表现。由于CDI在IBD恶化住院患者中的高患病率，以及CDI对这些患者的预后影响，建议对所有疾病发作住院的IBD患者进行艰难梭菌检测。治疗包括支持性护理和感染控制措施等一般措施。应尽快开始口服甲硝唑、万古霉素或新型抗生素非达霉素的抗生素治疗。粪便菌群移植是严重/复发性CDI的另一种可选治疗方法。本文的目的是回顾CDI在IBD中的最新数据：在发病机制中的作用，诊断方法，可选治疗和这些患者的结局。（三）2013年百世登出版集团有限公司版权所有。
Clostridium difficile (C. difficile) is the leading cause of antibiotic associated colitis and nosocomial diarrhea. Patients with inflammatory bowel disease (IBD) are at increased risk of developing C. difficile infection (CDI), have worse outcomes of CDI-including higher rates of colectomy and death, and experience higher rates of recurrence. However, it is still not clear whether C. difficile is a cause of IBD or a consequence of the inflammatory state in the intestinal environment. The burden of CDI has increased dramatically over the past decade, with severe outbreaks described in many countries, which have been attributed to a new and more virulent strain. A parallel rise in the incidence of CDI has been noted in patients with IBD. IBD patients with CDI tend be younger, have less prior antibiotic exposure, and most cases of CDI in these patients represent outpatient acquired infections. The clinical presentation of CDI in these patients can be unique-including diversion colitis, enteritis and pouchitis, and typical findings on colonoscopy are often absent. Due to the high prevalence of CDI in patients hospitalized with an IBD exacerbation, and the prognostic implications of CDI in these patients, it is recommended to test all IBD patients hospitalized with a disease flare for C. difficile. Treatment includes general measures such as supportive care and infection control measures. Antibiotic therapy with either oral metronidazole, vancomycin, or the novel antibiotic-fidaxomicin, should be initiated as soon as possible. Fecal macrobiota transplantation constitutes another optional treatment for severe/recurrent CDI. The aim of this paper is to review recent data on CDI in IBD: role in pathogenesis, diagnostic methods, optional treatments, and outcomes of these patients. (C) 2013 Baishideng Publishing Group co., Limited. All rights reserved.