Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA.
Clin Interv Aging. 2017 Oct 24;12:1799-1809. doi: 10.2147/CIA.S149089. eCollection 2017.
The burden of infection (CDI) is profound and growing. CDI now represents a common cause of health care-associated diarrhea, and is associated with significant morbidity, mortality, and health care costs. CDI disproportionally affects the elderly, possibly explained by the following risk factors: age-related impairment of the immune system, increasing antibiotic utilization, and frequent health care exposure. In the USA, recent epidemiological studies estimate that two out of every three health care-associated CDIs occur in patients 65 years or older. Additionally, the elderly are at higher risk for recurrent CDI. Existing therapeutic options include metronidazole, oral vancomycin, and fidaxomicin. Choice of agent depends on disease severity, history of recurrence, and, increasingly, the drug cost. Bezlotoxumab, a recently approved monoclonal antibody targeting toxin B, offers an exciting advancement into immunologic therapies. Similarly, fecal microbiota transplantation is gaining popularity as an effective option mainly for recurrent CDI. The challenge of decreasing CDI burden in the elderly involves adopting preventative strategies, optimizing initial treatment, and decreasing the risk of recurrence. Expanded strategies are certainly needed to improve outcomes in this high-risk population. This review considers available data from prospective and retrospective studies as well as case reports to illustrate the merits and gaps in care related to the management of CDI in the elderly.
感染负担（CDI）是深远且不断增加的。CDI 现在是医疗保健相关腹泻的常见病因，与显著的发病率、死亡率和医疗保健费用相关。CDI 不成比例地影响老年人，其可能的解释为以下风险因素：与年龄相关的免疫系统损伤、抗生素使用增加和频繁的医疗保健暴露。在美国，最近的流行病学研究估计，每三个医疗保健相关的 CDI 中有两个发生在 65 岁或以上的患者中。此外，老年人更易发生复发性 CDI。现有的治疗选择包括甲硝唑、口服万古霉素和非达霉素。药物的选择取决于疾病的严重程度、复发史，以及越来越多的药物成本。贝洛妥珠单抗，一种最近批准的靶向毒素 B 的单克隆抗体，为免疫治疗带来了令人兴奋的进展。同样，粪便微生物群移植作为一种有效的选择越来越受欢迎，主要用于复发性 CDI。减少老年人 CDI 负担的挑战涉及采用预防策略、优化初始治疗和降低复发风险。为了改善这一高风险人群的预后，肯定需要扩大策略。本综述考虑了来自前瞻性和回顾性研究以及病例报告的现有数据，以说明与老年人 CDI 管理相关的护理的优点和差距。
