Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA.
Gastroenterol Clin North Am. 2012 Jun;41(2):339-53. doi: 10.1016/j.gtc.2012.01.003. Epub 2012 Feb 14.
The prevalence of CDI in patients with IBD has increased over the last decade. The excess morbidity and mortality associated with CDI appears to be greater in patients with IBD than in those without preexisting bowel disease. The risk factors for CDI in IBD and non-IBD populations appear similar; unique IBD-related risk factors are use of maintenance immunosuppression and extent and severity of prior colitis. Nevertheless, a significant proportion of CDI-IBD patients may have the disease without traditional risk factors (ie, antibiotic use, recent hospitalization). The absence of such risk factors must not preclude considering CDI in the differential diagnosis of IBD patients presenting with a disease flare. Vancomycin and metronidazole appear to have similar efficacy with vancomycin being the preferred agent for severe disease. Early surgical consultation is key for improving outcomes of patients with severe disease. Several gaps in research exist; prospective multicenter cohorts of CDI-IBD are essential to improve our understanding of the impact of CDI on IBD patients and define appropriate therapeutic regimens to improve patient outcomes.
过去十年间，炎症性肠病（IBD）患者中艰难梭菌感染（CDI）的发病率有所上升。与无潜在肠道疾病的患者相比，IBD 患者中 CDI 相关的发病率和死亡率似乎更高。IBD 和非 IBD 人群中 CDI 的危险因素似乎相似；IBD 相关的独特危险因素是维持性免疫抑制和既往结肠炎的范围和严重程度。然而，相当一部分 CDI-IBD 患者可能在没有传统危险因素（即抗生素使用、近期住院）的情况下患有该病。在出现疾病发作的 IBD 患者中，没有这些危险因素也不能排除 CDI 的鉴别诊断。万古霉素和甲硝唑的疗效似乎相似，而万古霉素是治疗重症的首选药物。早期手术咨询是改善重症患者预后的关键。目前研究中存在一些空白；前瞻性的 CDI-IBD 多中心队列研究对于提高我们对 CDI 对 IBD 患者影响的认识以及确定改善患者预后的适当治疗方案至关重要。
