Department of Medicine for the Older Person, Mater Misericordiae University Hospital, Ireland.
Curr Opin Gastroenterol. 2011 Jan;27(1):38-47. doi: 10.1097/MOG.0b013e3283411634.
This review summarizes the most recent epidemiological data and advances in research into the pathogenesis, diagnosis and treatment of Clostridium difficile infection (CDI).
The epidemiology of CDI has changed with the emergence of hypervirulent strains. CDI rates have increased in the community, in children and in patients with inflammatory bowel disease. Although the North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis group BI, PCR ribotype 027 (NAP1/BI/027) strain remains prevalent in North America, surveillance suggests that it is decreasing in Europe. A similar strain, PCR ribotype 078, is emerging which is associated with community-associated CDI and has been isolated in animals and food products. The Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America have published new guidelines on the epidemiology, diagnosis, treatment, infection control and environmental management of C. difficile. Several novel therapies for CDI are at different stages of development. There have been promising trial results with fidaxomicin, a novel antibiotic for the treatment of CDI and monoclonal antibodies against toxins A and B, which have been shown to significantly reduce CDI recurrence rates.
Major advances have been made in our understanding of the spread and pathogenesis of C. difficile and new treatment options are becoming available.
本综述总结了艰难梭菌感染（CDI）发病机制、诊断和治疗的最新流行病学数据和研究进展。
随着强毒株的出现，CDI 的流行病学发生了变化。社区、儿童和炎症性肠病患者中的 CDI 发生率增加。虽然北美脉冲场凝胶电泳型 1、限制内切酶分析组 BI、PCR 核糖体型 027（NAP1/BI/027）菌株仍在北美流行，但监测表明其在欧洲的流行率正在下降。一种类似的菌株，PCR 核糖体型 078，正在出现，与社区获得性 CDI 相关，并已在动物和食品中分离出来。美国医疗保健流行病学学会和美国传染病学会发布了艰难梭菌的流行病学、诊断、治疗、感染控制和环境管理的新指南。有几种新型 CDI 疗法处于不同的开发阶段。在治疗 CDI 的新型抗生素非达霉素和针对毒素 A 和 B 的单克隆抗体的试验中取得了有希望的结果，这些药物显著降低了 CDI 的复发率。
我们对艰难梭菌的传播和发病机制的理解取得了重大进展，并且新的治疗选择正在出现。
