Leffler Daniel A, Lamont J Thomas
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Gastroenterology. 2009 May;136(6):1899-912. doi: 10.1053/j.gastro.2008.12.070. Epub 2009 May 7.
Clostridium difficile infection is an increasing burden to the health care system, totaling more than $1 billion/year in the United States. Treatment of patients with C difficile infection with metronidazole or vancomycin reduces morbidity and mortality, although the number of patients that do not respond to metronidazole is increasing. Despite initial response rates of greater than 90%, 15%-30% of patients have a relapse in symptoms after successful initial therapy, usually in the first few weeks after treatment is discontinued. Failure to develop specific antibody response has recently been identified as a critical factor in recurrence. The review discusses the different management strategies for initial and recurrent symptomatic C difficile infections.
艰难梭菌感染给医疗保健系统带来的负担日益加重，在美国每年总计超过10亿美元。用甲硝唑或万古霉素治疗艰难梭菌感染患者可降低发病率和死亡率，尽管对甲硝唑无反应的患者数量在增加。尽管初始缓解率超过90%，但15% - 30%的患者在初始治疗成功后症状会复发，通常在治疗停止后的头几周内。最近已确定未能产生特异性抗体反应是复发的关键因素。本文综述讨论了初发和复发性有症状艰难梭菌感染的不同管理策略。
