Seltman Ann K
Colon and Rectal Surgery Associates Ltd., St. Paul, Minnesota ; Division of Colon and Rectal Surgery, University of Minnesota, St. Paul, Minnesota.
Clin Colon Rectal Surg. 2012 Dec;25(4):204-9. doi: 10.1055/s-0032-1329390.
Clostridium difficile infection (CDI) will progress to fulminant disease in 3 to 5% of cases. With the emergence of hypervirulent, multidrug-resistant strains, the incidence and severity of disease are continuing to rise. Prompt identification, early resuscitation, and treatment are critical in preventing morbidity and mortality in this increasingly common condition. Discontinuation of antibiotics and treatment with oral vancomycin and intravenous or oral metronidazole are first-line treatments, but complicated cases may require surgery. Subtotal colectomy with ileostomy remains the standard of care when toxic megacolon, perforation, or an acute surgical abdomen is present, but mortality rates are high. Recognition of risk factors for fulminant CDI and earlier surgical intervention may decrease mortality from this highly lethal disease.
艰难梭菌感染（CDI）在3%至5%的病例中会进展为暴发性疾病。随着高毒力、多重耐药菌株的出现，疾病的发病率和严重程度持续上升。在这种日益常见的疾病中，及时识别、早期复苏和治疗对于预防发病和死亡至关重要。停用抗生素并使用口服万古霉素以及静脉或口服甲硝唑进行治疗是一线治疗方法，但复杂病例可能需要手术。当出现中毒性巨结肠、穿孔或急性急腹症时，行回肠造口术的次全结肠切除术仍是标准治疗方法，但死亡率很高。认识到暴发性CDI的危险因素并尽早进行手术干预可能会降低这种高致死性疾病的死亡率。
