Rao Krishna, Higgins Peter D R
*Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; †Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan; ‡Division of Infectious Diseases, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan; and §Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
Inflamm Bowel Dis. 2016 Jul;22(7):1744-54. doi: 10.1097/MIB.0000000000000793.
Clostridium difficile infection (CDI) is a major source of morbidity and mortality for the U.S. health care system and frequently complicates the course of inflammatory bowel disease (IBD). Patients with IBD are more likely to be colonized with C. difficile and develop active infection than the general population. They are also more likely to have severe CDI and develop subsequent complications such as IBD flare, colectomy, or death. Even after successful initial treatment and recovery, recurrent CDI is common. Management of CDI in IBD is fraught with diagnostic and therapeutic challenges because the clinical presentations of CDI and IBD flare have considerable overlap. Fecal microbiota transplantation can be successful in curing recurrent CDI when other treatments have failed, but may also trigger IBD flare and this warrants caution. New experimental treatments including vaccines, monoclonal antibodies, and nontoxigenic strains of C. difficile offer promise but are not yet available for clinicians. A better understanding of the complex relationship between the gut microbiota, CDI, and IBD is needed.
艰难梭菌感染（CDI）是美国医疗保健系统发病和死亡的主要原因，并且常使炎症性肠病（IBD）的病程复杂化。与普通人群相比，IBD患者更易被艰难梭菌定植并发生活动性感染。他们也更有可能发生严重的CDI，并出现诸如IBD发作、结肠切除术或死亡等后续并发症。即使在初始治疗成功并康复后，复发性CDI也很常见。IBD中CDI的管理充满了诊断和治疗挑战，因为CDI和IBD发作的临床表现有相当大的重叠。当其他治疗失败时，粪便微生物群移植可成功治愈复发性CDI，但也可能引发IBD发作，这一点值得谨慎对待。包括疫苗、单克隆抗体和艰难梭菌无毒菌株在内的新实验性治疗方法有前景，但临床医生目前还无法使用。需要更好地了解肠道微生物群、CDI和IBD之间的复杂关系。
