Cojocariu C, Trifan A, Stoica O, Chihaia C A, Stanciu C
Chirurgia (Bucur). 2014 Sep-Oct;109(5):579-83.
Over the past two decades there has been a dramatic increase worldwide in both incidence and severity of Clostridium difficile infection (CDI). Paralleling the rising incidence of CDI in the general population, there has been an even higher increase in the incidence of CDI among patients with inflammatory bowel disease (IBD). CDI may mimic a flare of IBD as symptoms and laboratory parameters are often similar, and therefore, screening for CDI is recommended at every flare in such patients. Enzyme immunoassay to detect Clostridium difficile toxin A and B in stool is still the most widely used test for CDI diagnosis despite its low sensitivity. Metronidazole for mild/moderate CDI,and vancomycin for severe CDI are the preferred agents for the treatment of infection. CDI has a negative impact both on short- and long- term IBD outcomes, increasing the need for surgery, as well as the mortality rate and healthcare costs. All gastroenterologists and surgeons should have a high index of suspicion for CDI when evaluating a patient with IBD flare, as prompt diagnosis and adequate treatment of infection improve outcomes. Measures must be taken to prevent spreading of infection in gastroenterology /surgery settings.
在过去二十年中，全球艰难梭菌感染（CDI）的发病率和严重程度均显著上升。与普通人群中CDI发病率上升相平行的是，炎症性肠病（IBD）患者中CDI的发病率升幅更高。由于症状和实验室指标通常相似，CDI可能会模拟IBD的发作，因此，建议对这类患者每次发作时都进行CDI筛查。尽管酶免疫测定法检测粪便中艰难梭菌毒素A和B的灵敏度较低，但它仍是目前CDI诊断中使用最广泛的检测方法。甲硝唑用于治疗轻/中度CDI，万古霉素用于治疗重度CDI，是治疗感染的首选药物。CDI对IBD的短期和长期预后均有负面影响，增加了手术需求、死亡率以及医疗成本。所有胃肠病学家和外科医生在评估IBD发作的患者时，都应高度怀疑CDI，因为及时诊断和充分治疗感染可改善预后。必须采取措施防止在胃肠病学/外科环境中传播感染。
