Oldfield Edward C
Division of Infectious Disease, Department of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Rev Gastroenterol Disord. 2006 Spring;6(2):79-96.
There has been a significant increase in the incidence and severity of Clostridium difficile-associated diarrhea (CDAD) in the past several years, including outbreaks in multiple states and provinces in the United States and Canada, as well as in the United Kingdom. A new, highly virulent strain of C. difficile has appeared that is less responsive to standard therapy and associated with a high rate of recurrence. Along with nosocomially acquired infections there has been a rise in the number of community-acquired cases of CDAD, even among those without prior antibiotic exposure. Many factors have contributed to this epidemic, including the development of resistance to the widely used fluoroquinolones class of antibiotics. Because this new strain is less responsive to standard therapy, particularly metronidazole, a number of new antibiotics and other therapies are actively being investigated for use in both primary and recurrent CDAD. A multifaceted approach to managing CDAD is called for, including active surveillance, antibiotic stewardship, and meticulous attention to contact precautions, including gloves, gowns, and hand washing.
在过去几年中，艰难梭菌相关性腹泻（CDAD）的发病率和严重程度显著增加，包括在美国和加拿大的多个州和省份以及英国爆发。一种新的、高毒力的艰难梭菌菌株出现了，它对标准治疗的反应较差，且复发率高。除了医院获得性感染外，社区获得性CDAD病例的数量也有所增加，甚至在那些没有先前抗生素暴露史的人群中也是如此。许多因素导致了这一流行，包括对广泛使用的氟喹诺酮类抗生素产生耐药性。由于这种新菌株对标准治疗，特别是甲硝唑反应较差，许多新的抗生素和其他疗法正在积极研究用于原发性和复发性CDAD。需要一种多方面的方法来管理CDAD，包括主动监测、抗生素管理以及严格注意接触预防措施，包括戴手套、穿隔离衣和洗手。
