Clostridium difficile Infection.
Clostridium difficile Infection.
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DOI：
10.1128/microbiolspec.ei10-0007-2015
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发表时间：
2016-06
影响因子：
3.7
通讯作者：
Warren CA
中科院分区：
文献类型：
--
作者：
Shin JH;Chaves-Olarte E;Warren CA
艰难梭菌是一种厌氧、革兰氏阳性、芽胞形成、毒素分泌的细菌，长期以来一直被认为是抗生素相关性腹泻的最常见病原菌。艰难梭菌感染(CDI)现在是美国卫生保健相关感染的最常见原因，占这些感染的12%(Magill SS等人，N Engl J Med 370：1198-1208,2014)。在美国具有公共卫生重要性的新兴病原体中，CDI的人口发病率最高，估计为每10万人中有147人(Lessa FC等人，N Engl J Med 372：825-834,2015)。在一份关于抗菌素耐药性的报告中，艰难梭菌被疾病控制和预防中心归类为三大紧急威胁之一(http://www.cdc.gov/drugresistance/threat-report-2013/).虽然艰难梭菌最初是在20世纪70年代末被描述的，但在过去的十年里，出现了高毒素菌株，导致全球发病率和死亡率的增加。致病菌株、宿主易感性和其他区域性因素各不相同，可能会影响临床表现和干预方法。在这篇文章中，我们描述了CDI的全球流行病学特征，这些不同的毒株在北美和欧洲以外的地方传播，NAP1/027/BI/III最初在那里获得了突出的地位。卫生保健环境中的老年人口受到的影响不成比例，但同样有报告称，在社区环境中儿童和健康的年轻人出现了CDI。讨论了管理的新方法，包括粪便微生物区系移植。
Clostridium difficile is an anaerobic, Gram-positive, spore-forming, toxin-secreting bacillus that has long been recognized to be the most common etiologic pathogen of antibiotic-associated diarrhea. C. difficile infection (CDI) is now the most common cause of health care–associated infections in the United States and accounts for 12% of these infections (Magill SS et al., N Engl J Med 370:1198–1208, 2014). Among emerging pathogens of public health importance in the United States, CDI has the highest population-based incidence, estimated at 147 per 100,000 (Lessa FC et al., N Engl J Med 372:825–834, 2015). In a report on antimicrobial resistance, C. difficile has been categorized by the Centers for Disease Control and Prevention as one of three “urgent” threats (http://www.cdc.gov/drugresistance/threat-report-2013/). Although C. difficile was first described in the late 1970s, the past decade has seen the emergence of hypertoxigenic strains that have caused increased morbidity and mortality worldwide. Pathogenic strains, host susceptibility, and other regional factors vary and may influence the clinical manifestation and approach to intervention. In this article, we describe the global epidemiology of CDI featuring the different strains in circulation outside of North America and Europe where strain NAP1/027/BI/III had originally gained prominence. The elderly population in health care settings has been disproportionately affected, but emergence of CDI in children and healthy young adults in community settings has, likewise, been reported. New approaches in management, including fecal microbiota transplantation, are discussed.