Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98104, USA.
Am J Gastroenterol. 2013 Apr;108(4):478-98; quiz 499. doi: 10.1038/ajg.2013.4. Epub 2013 Feb 26.
Clostridium difficile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratified depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mild-to-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classification of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI.
艰难梭菌感染（CDI）是医院相关性胃肠道疾病的主要病因，给我们的医疗体系带来了沉重的负担。艰难梭菌感染患者通常在医院的住院时间延长，并且 CDI 是医院内大规模疾病爆发的常见原因。本指南为艰难梭菌感染患者的诊断和管理以及爆发的预防和控制提供了建议，同时补充了以前发布的指南。新的分子诊断粪便检测试验可能会取代当前的酶免疫检测试验。我们建议根据患者的疾病严重程度进行分层治疗，分为轻度至中度、重度或复杂疾病。甲硝唑治疗仍然是轻度至中度疾病的选择，但对于重度或复杂疾病的患者可能不够。我们提出了一种疾病严重程度的分类方法来指导治疗，这对临床医生很有用。我们回顾了复发性 CDI 患者的当前治疗选择以及 CDI 爆发的控制和预防建议。
