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老年宿主艰难梭菌感染抗生素治疗中的附带损害：复发疾病发生的原因分析。

Collateral damage during antibiotic treatment of C. difficile infection in the aged host: Insights into why recurrent disease happens.

机构信息

a University of Virginia School of Medicine , Department of Medicine, Division of Infectious Diseases and International Health.

出版信息

Gut Microbes. 2017 Sep 3;8(5):504-510. doi: 10.1080/19490976.2017.1323616. Epub 2017 Apr 28.

DOI:10.1080/19490976.2017.1323616
PMID:28453386
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5628656/
Abstract

Clostridium difficile infection (CDI) is one of the most common causes of healthcare-associated infections but an even bigger problem for the aging population. Advanced age leads to higher incidence, higher mortality, and higher recurrences. In our study, recently published in the Journal of Infectious Diseases, we investigated the effect of aging on CDI using a mouse model. We were able to demonstrate that aging leads to worse clinical outcomes, as well as lead to changes in microbiota composition and lower antibody production against C. difficile toxin A, but not toxin B. An association between advanced age and lower antibody production against C. difficile is a new finding which would explain the effect of aging on CDI outcome. Vancomycin, an anti-C. difficile antibiotic, led to similar changes in antibody response, suggesting a connection between microbiome and antibody response in the context of aging, which would require a much more nuanced look at the treatment of CDI.

摘要

艰难梭菌感染（CDI）是最常见的医疗相关感染之一，但对老年人群体来说更是一个大问题。随着年龄的增长，其发病率、死亡率和复发率都会更高。在我们最近发表在《传染病杂志》上的研究中，我们使用小鼠模型研究了年龄对 CDI 的影响。我们能够证明，衰老会导致更糟糕的临床结果，并导致微生物群落组成的变化以及针对艰难梭菌毒素 A 的抗体产生减少，但对毒素 B 没有影响。年龄增长与针对艰难梭菌的抗体产生减少之间存在关联，这是一个新发现，它可以解释衰老对 CDI 结果的影响。万古霉素是一种抗艰难梭菌的抗生素，它也会导致抗体反应产生类似的变化，这表明在衰老的背景下，微生物组和抗体反应之间存在联系，这需要更细致地研究 CDI 的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/5e9c41026dcb/kgmi-08-05-1323616-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/a7447f4ba471/kgmi-08-05-1323616-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/d408c58c6960/kgmi-08-05-1323616-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/5e9c41026dcb/kgmi-08-05-1323616-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/a7447f4ba471/kgmi-08-05-1323616-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/d408c58c6960/kgmi-08-05-1323616-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d9e5/5628656/5e9c41026dcb/kgmi-08-05-1323616-g003.jpg

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本文引用的文献

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N Engl J Med. 2017 Jan 26;376(4):305-317. doi: 10.1056/NEJMoa1602615.
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The microbiota in adaptive immune homeostasis and disease.
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Analysis of the impact of secondary prophylaxis on recurrence in critically ill adults.二级预防对重症成年患者复发影响的分析
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Aging exacerbates mortality of pneumonia and reduces the efficacies of antibiotics and vaccine.衰老会加剧肺炎导致的死亡率，并降低抗生素和疫苗的疗效。
Aging (Albany NY). 2018 Jul 18;10(7):1597-1608. doi: 10.18632/aging.101495.
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