Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2012 Aug;55 Suppl 2(Suppl 2):S65-70. doi: 10.1093/cid/cis319.
The dramatic changes in the epidemiology of Clostridium difficile infection (CDI) during recent years, with increases in incidence and severity of disease in several countries, have made CDI a global public health challenge. Increases in CDI incidence have been largely attributed to the emergence of a previously rare and more virulent strain, BI/NAP1/027. Increased toxin production and high-level resistance to fluoroquinolones have made this strain a very successful pathogen in healthcare settings. In addition, populations previously thought to be at low risk are now being identified as having severe CDI. Recent genetic analysis suggests that C. difficile has a highly fluid genome with multiple mechanisms to modify its content and functionality, which can make C. difficile adaptable to environmental changes and potentially lead to the emergence of more virulent strains. In the face of these changes in the epidemiology and microbiology of CDI, surveillance systems are necessary to monitor trends and inform public health actions.
近年来，艰难梭菌感染（CDI）的流行病学发生了巨大变化，在多个国家疾病的发病率和严重程度都有所增加，这使得 CDI 成为了一个全球性的公共卫生挑战。CDI 发病率的增加主要归因于一种以前罕见但毒力更强的菌株 BI/NAP1/027 的出现。该菌株增加了毒素的产生并对氟喹诺酮类药物具有高水平的耐药性，使其成为医疗机构中非常成功的病原体。此外，以前被认为风险较低的人群现在也被确定为患有严重的 CDI。最近的遗传分析表明，艰难梭菌具有高度流动的基因组，有多种机制可以改变其内容和功能，这使得艰难梭菌能够适应环境变化，并可能导致更具毒性的菌株的出现。面对 CDI 的流行病学和微生物学的这些变化，有必要建立监测系统来监测趋势并为公共卫生行动提供信息。
