Honda Hitoshi, Dubberke Erik R
aDivision of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan bDivision of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Curr Opin Infect Dis. 2014 Aug;27(4):336-41. doi: 10.1097/QCO.0000000000000075.
Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections, and the threat associated with CDI continues to grow in all patient populations. There is increasing evidence that CDI has a substantial impact on the morbidity and mortality in solid organ transplant (SOT) recipients. Furthermore, new diagnostic and treatment options and strategies for CDI have emerged over the last decade. The purpose of this review is to provide a general understanding of CDI and its evidence-based diagnosis and management strategies, with a focus on SOT recipients.
The incidence and severity of CDI have significantly increased since the year 2000. Studies have identified novel risk factors for CDI, and a new epidemic strain, the NAP1/BI/027, has emerged. Despite the development of newer testing methods and approaches, including nucleic acid amplification tests and testing algorithms, the optimal method for diagnosing CDI is an area of controversy. New agents for treating CDI are being developed, and the use of fecal microbiota transplantation to treat recurrent CDI in SOT recipients is also evolving.
CDI is a significant problem for SOT recipients. Further studies on diagnostic and therapeutic strategies with a focus on SOT recipients are needed to further improve patient outcomes.
艰难梭菌感染(CDI)是最常见的医疗保健相关感染之一,且在所有患者群体中,与CDI相关的威胁持续增加。越来越多的证据表明,CDI对实体器官移植(SOT)受者的发病率和死亡率有重大影响。此外,在过去十年中出现了CDI的新诊断和治疗选择及策略。本综述的目的是提供对CDI及其循证诊断和管理策略的总体认识,重点关注SOT受者。
自2000年以来,CDI的发病率和严重程度显著增加。研究已确定CDI的新危险因素,并且出现了一种新的流行菌株,即NAP1/BI/027。尽管开发了更新的检测方法和途径,包括核酸扩增检测和检测算法,但诊断CDI的最佳方法仍是一个有争议的领域。治疗CDI的新药物正在研发中,粪便微生物群移植用于治疗SOT受者复发性CDI的应用也在不断发展。
CDI是SOT受者面临的一个重大问题。需要针对SOT受者进一步开展诊断和治疗策略研究,以进一步改善患者预后。