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艰难梭菌感染的诊断与治疗临床进展

Clinical update for the diagnosis and treatment of Clostridium difficile infection.

作者信息

Oldfield Edward C, Oldfield Edward C, Johnson David A

机构信息

Edward C Oldfield IV, Edward C Oldfield III, David A Johnson, Division of Gastroenterology, Division of Infectious Disease, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23508, United States.

出版信息

World J Gastrointest Pharmacol Ther. 2014 Feb 6;5(1):1-26. doi: 10.4292/wjgpt.v5.i1.1.

Abstract

Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospital-acquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies.

摘要

艰难梭菌感染(CDI)在抗击医院获得性感染的斗争中呈现出一个迅速演变的挑战。CDI诊断和管理的最新进展包括随着更新的检测方法的引入,诊断方法发生了快速变化,如粪便中谷氨酸脱氢酶的检测以及用于检测毒素产生基因的聚合酶链反应,这将很快彻底改变CDI的诊断方法。新药物和多个医学学会指南在CDI严重程度的定义和治疗药物的选择方面引入了不断变化的概念,而粪便微生物群移植疗效数据的迅速扩展预示着CDI多次复发患者管理方面的革命性变化。通过对当前医学文献的全面综述,本文旨在对CDI诊断的现状进行深入回顾,讨论现有实验室检测的优缺点,比较当前和未来的治疗选择,并为最佳实践策略提供建议。

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