Stallmach A
Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
Internist (Berl). 2016 Dec;57(12):1182-1190. doi: 10.1007/s00108-016-0149-0.
Clostridium difficile (C. difficile) is an anaerobic, Gram-positive, spore-forming, toxin-secreting bacillus. It is transmitted via a fecal-oral route and can be found in 1-3 % of the healthy population. Symptoms caused by C. difficile range from uncomplicated diarrhea to a toxic megacolon. The incidence, frequency of recurrence, and mortality rate of C. difficile infections (CDIs) have increased significantly over the past few decades. The most important risk factor is antibiotic treatment in elderly patients and patients with severe comorbidities. There is a screening test available to detect C. difficile-specific glutamate dehydrogenase (GDH), which is produced by both toxigenic and non-toxigenic strains. To confirm CDIs, it is necessary to test for toxins in a fresh, liquid stool sample via polymerase chain reaction or an enzyme-coupled immune adsorption test. If CDIs are diagnosed, then ongoing antibiotic treatment should be ended. Metronidazole is used to treat mild cases, and vancomycin is recommended for severe cases. Vancomycin or fidaxomicin should be used to treat recurrences (10-25 % of patients). In cases with several recurrences, a treatment option is fecal microbiome transfer (FMT). The cure rate following FMT is approximately 80 %. The treatment of severe and complicated CDI with a threatening toxic megacolon remains problematic. The degree of evidence of medicated treatment in this situation is low; the significance of metronidazole i. v. as an additional therapeutic measure is controversial. Tigecycline i. v. is an alternative option. Surgical treatment must be considered in patients with a toxic megacolon or an acute abdomen.
艰难梭菌是一种厌氧、革兰氏阳性、产芽孢、分泌毒素的杆菌。它通过粪口途径传播，在1%至3%的健康人群中可以检测到。艰难梭菌引起的症状范围从不复杂的腹泻到中毒性巨结肠。在过去几十年中，艰难梭菌感染（CDI）的发病率、复发频率和死亡率显著增加。最重要的危险因素是老年患者和患有严重合并症患者的抗生素治疗。有一种筛查试验可用于检测艰难梭菌特异性谷氨酸脱氢酶（GDH），产毒菌株和无毒菌株均可产生该酶。为确诊CDI，有必要通过聚合酶链反应或酶联免疫吸附试验在新鲜的液体粪便样本中检测毒素。如果确诊为CDI，则应停止正在进行的抗生素治疗。甲硝唑用于治疗轻症病例，重症病例推荐使用万古霉素。复发病例（10%至25%的患者）应使用万古霉素或非达霉素治疗。对于多次复发的病例，一种治疗选择是粪便微生物群移植（FMT）。FMT后的治愈率约为80%。伴有威胁生命的中毒性巨结肠的严重和复杂CDI的治疗仍然存在问题。在这种情况下药物治疗的证据级别较低；静脉注射甲硝唑作为额外治疗措施的意义存在争议。静脉注射替加环素是一种替代选择。对于患有中毒性巨结肠或急腹症的患者，必须考虑手术治疗。
