Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
J Clin Gastroenterol. 2011 Nov;45 Suppl(Suppl):S154-8. doi: 10.1097/MCG.0b013e31822ec787.
Clostridium difficile infection (CDI) is one of the most prevalent nosocomial infections. A dramatic increase in the incidence and severity of CDI has been noted in the past decade. Current recommendations suggest metronidazole as first-line therapy in mild to moderately severe CDI and oral vancomycin in individuals with severe CDI, or when metronidazole fails or is contradicted. Alterations of the colonic microbiota, usually caused by antimicrobial therapy, seem to play a critical role in CDI pathogenesis. Probiotics are live microorganisms that confer a health benefit to the host, and have been used in CDI. Although a wide variety of probiotics have been studied, the exact role of probiotics in preventing and treating CDI is not clear. In this study, we reviewed the current literature and recommendations on the most commonly studied protiotic agents (Saccharomyces boulardii, Lactobacillus species, and probiotic mixtures) used to prevent or treat CDI. Lactobacillus-containing probiotic mixtures and S. boulardii may be effective in the prevention of CDI in high-risk antibiotic recipients but this finding is based on small, individual studies, and further, larger, well-controlled studies are needed to confirm preliminary positive findings and to better delineate the efficacy of probiotics in CDI prevention or treatment.
艰难梭菌感染（CDI）是最常见的医院获得性感染之一。在过去的十年中，CDI 的发病率和严重程度显著增加。目前的建议建议甲硝唑作为轻度至中度 CDI 的一线治疗药物，口服万古霉素用于严重 CDI 或甲硝唑失败或有禁忌的患者。结肠微生物群的改变，通常由抗菌治疗引起，似乎在 CDI 的发病机制中起关键作用。益生菌是赋予宿主健康益处的活微生物，并已用于 CDI。尽管已经研究了各种各样的益生菌，但益生菌在预防和治疗 CDI 中的确切作用尚不清楚。在这项研究中，我们回顾了目前关于最常研究的益生菌制剂（布拉氏酵母菌、乳酸杆菌属和益生菌混合物）用于预防或治疗 CDI 的文献和建议。含乳酸杆菌的益生菌混合物和布拉氏酵母菌可能对高风险抗生素接受者预防 CDI 有效，但这一发现基于小型的、单独的研究，需要进一步进行更大规模、对照良好的研究来证实初步的阳性发现，并更好地阐明益生菌在 CDI 预防或治疗中的疗效。
