Martin Jessica, Wilcox Mark
aLeeds Teaching Hospitals NHS Trust/University of Leeds, Microbiology, Old Medical School, Leeds General Infirmary bLeeds Teaching Hospitals NHS Trust cUniversity of Leeds, Leeds dPublic Health England, UK.
Curr Opin Infect Dis. 2016 Dec;29(6):546-554. doi: 10.1097/QCO.0000000000000320.
Clostridium difficile infection has attained high prominence given its prevalence and impacts on patients and healthcare institutions. Multiple new approaches to the prevention and treatment of C. difficile infection (CDI) are undergoing clinical trials.
Bezlotoxumab is a monoclonal antibody against toxin B that has successfully completed phase III studies, demonstrating a significant reduction in recurrent CDI when given with standard of care antibiotics. Antibiotics under development include cadazolid and ridinilazole, whereas surotomycin has had disappointing phase III results. Multiple live biotherapeutics are being developed, including freeze thawed and encapsulated versions of faecal microbiota transplantation to improve the practicality of treating patients with recurrent CDI. Alternatives to faecal microbiota transplantation, that aim to improve safety, including a microbial suspension, RBX2660, and a complex spore formulation, SER-109, have progressed to phase II studies. A nontoxigenic C. difficile strain has also shown promise to prevent recurrent CDI. In addition, three C. difficile vaccines have progressed to phase II/III clinical trials.
The diverse approaches to treating and preventing CDI offer substantial promise that new treatment options will soon emerge, particular ones that reduce the risk of recurrences.
鉴于艰难梭菌感染的患病率及其对患者和医疗机构的影响，该感染已备受关注。多种预防和治疗艰难梭菌感染（CDI）的新方法正在进行临床试验。
贝佐妥昔单抗是一种抗毒素B的单克隆抗体，已成功完成III期研究，表明与标准护理抗生素联合使用时，复发性CDI显著减少。正在研发的抗生素包括卡达唑胺和利迪尼唑，而舒罗霉素在III期研究中结果令人失望。正在开发多种活生物疗法，包括冻融和封装的粪便微生物群移植，以提高治疗复发性CDI患者的实用性。旨在提高安全性的粪便微生物群移植替代方法，包括一种微生物悬液RBX2660和一种复合孢子制剂SER-109，已进入II期研究。一种非产毒艰难梭菌菌株在预防复发性CDI方面也显示出前景。此外，三种艰难梭菌疫苗已进入II/III期临床试验。
治疗和预防CDI的多种方法带来了很大希望，即很快会出现新的治疗选择，尤其是能降低复发风险的选择。
