Peretz Avi, Shlomo Izhar Ben, Nitzan Orna, Bonavina Luigi, Schaffer Pmela M, Schaffer Moshe
Baruch Padeh Medical Center & Faculty of Medicine in the Galilee, Bar Ilan University - Obstetrics & Gynecology, PORIYA M.P. Lower Galilee 15208, Tiberias 15208, Israel.
Curr Med Chem. 2016;23(39):4442-4449. doi: 10.2174/0929867323666161028162018.
Although mucositis, diarrhea, and constipation as well as immunosuppression are well recognized side-effects of cancer treatment, the underlying mechanisms including changes in the composition of gut microbiota and Clostridium difficile infection have not yet been thoroughly reviewed.
We herein set out to review the literature regarding the relations between cancer chemotherapy, radiation treatment, and Clostridium difficile-associated colitis.
Review of the English language literature published from 2008 to 2015 on the association between cancer chemotherapy, radiation treatment, and C. difficile-associated colitis.
Certain chemotherapeutic combinations, mainly those containing paclitaxel, are more likely to be followed by C. difficile infection (CDI), while some tumor types are more likely to be complicated by CDI following chemotherapy. CDI following irradiation occurs mostly in patients who were treated for cancer in the head and neck area. Risk factors found were proton pump inhibitors, antibiotics, cytostatic agents, and tube feeding. The drug of choice for an initial episode of mild-to-moderate CDI is metronidazole, whereas vancomycin is reserved for an initial episode of severe CDI. Fidaxomycin is another option for treatment of severe CDI, with fewer recurrences.
The influence of CDI on the treatment of oncological patients is not fully acknowledged. Infection with C. difficile is more frequent in those patients treated by antibiotics simultaneously with chemotherapy. Aggressive supportive care with intravenous hydration, antibiotics, and close surgical monitoring for selective intervention can significantly decrease the morbidity and life-threatening complications associated with this infection.
尽管黏膜炎、腹泻、便秘以及免疫抑制是癌症治疗中公认的副作用，但其潜在机制，包括肠道微生物群组成的变化和艰难梭菌感染，尚未得到全面综述。
我们在此着手综述关于癌症化疗、放射治疗与艰难梭菌相关性结肠炎之间关系的文献。
回顾2008年至2015年发表的关于癌症化疗、放射治疗与艰难梭菌相关性结肠炎之间关联的英文文献。
某些化疗组合，主要是那些含有紫杉醇的组合，更有可能继发艰难梭菌感染（CDI），而某些肿瘤类型在化疗后更有可能并发CDI。放疗后的CDI大多发生在头颈部癌症患者中。发现的危险因素有质子泵抑制剂、抗生素、细胞毒性药物和管饲。轻至中度CDI初始发作的首选药物是甲硝唑，而万古霉素则用于严重CDI的初始发作。非达霉素是治疗严重CDI的另一种选择，复发较少。
CDI对肿瘤患者治疗的影响尚未得到充分认识。在同时接受抗生素和化疗的患者中，艰难梭菌感染更为常见。积极的支持性治疗，包括静脉补液、使用抗生素以及密切的手术监测以进行选择性干预，可以显著降低与这种感染相关的发病率和危及生命的并发症。
