European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection
European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection
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DOI：
10.1111/1469-0691.12418
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发表时间：
2014-03-01
影响因子：
14.2
通讯作者：
Kuijper, E. J.
中科院分区：
文献类型：
--
作者：
Debast, S. B.;Bauer, M. P.;Kuijper, E. J.
2009年，欧洲临床微生物学和感染学会（ESCMID）发布了第一份艰难梭菌感染（CDI）治疗指导文件。该指南已广泛应用于临床实践。在本文件中，对目前可用的CDI治疗方式的比较有效性进行了更新和审查，从而提供了关于这个问题的循证建议。进行了计算机文献检索，以调查干预对CDI临床结局的影响的随机和非随机试验。推荐评估、发展和评价等级（GRADE）系统用于对我们的推荐的强度和证据的质量进行分级。ESCMID和来自11个欧洲国家的国际专家组支持这一进程。为了改善CDI治疗的临床指导，针对不同的患者群体制定了建议，例如初始非严重疾病、严重CDI、首次复发或疾病复发风险、多次复发以及无法口服时的CDI治疗。审查的治疗方案包括：抗生素，毒素结合树脂和聚合物，免疫疗法，益生菌，粪便或细菌肠道移植。除了明显由抗生素使用引起的非常轻微的CDI外，建议使用抗生素治疗。推荐的主要抗生素是甲硝唑、万古霉素和非达霉素。对于多次复发的CDI，强烈建议进行粪便移植。如果出现结肠穿孔和/或全身性炎症，且尽管使用了抗生素，但临床状况仍在恶化，则建议进行全腹结肠切除术或回肠造口术，并结合结肠灌洗。
In 2009 the first European Society of Clinical Microbiology and Infection (ESCMID) treatment guidance document for Clostridium difficile infection (CDI) was published. The guideline has been applied widely in clinical practice. In this document an update and review on the comparative effectiveness of the currently available treatment modalities of CDI is given, thereby providing evidence-based recommendations on this issue. A computerized literature search was carried out to investigate randomized and non-randomized trials investigating the effect of an intervention on the clinical outcome of CDI. The Grades of Recommendation Assessment, Development and Evaluation (GRADE) system was used to grade the strength of our recommendations and the quality of the evidence. The ESCMID and an international team of experts from 11 European countries supported the process. To improve clinical guidance in the treatment of CDI, recommendations are specified for various patient groups, e.g. initial non-severe disease, severe CDI, first recurrence or risk for recurrent disease, multiple recurrences and treatment of CDI when oral administration is not possible. Treatment options that are reviewed include: antibiotics, toxin-binding resins and polymers, immunotherapy, probiotics, and faecal or bacterial intestinal transplantation. Except for very mild CDI that is clearly induced by antibiotic usage antibiotic treatment is advised. The main antibiotics that are recommended are metronidazole, vancomycin and fidaxomicin. Faecal transplantation is strongly recommended for multiple recurrent CDI. In case of perforation of the colon and/or systemic inflammation and deteriorating clinical condition despite antibiotic therapy, total abdominal colectomy or diverting loop ileostomy combined with colonic lavage is recommended.