Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
Clin Microbiol Infect. 2018 May;24(5):476-482. doi: 10.1016/j.cmi.2017.11.017. Epub 2017 Dec 5.
Recurrent Clostridium difficile infection (rCDI) places a huge economic and practical burden on healthcare facilities. Furthermore, rCDI may affect quality of life, leaving patients in an rCDI cycle and dependant on antibiotic therapy.
To discuss the importance of microbiologic factors in the development of rCDI.
Literature was drawn from a search of PubMed from 2000 onwards with the search term 'recurrent Clostridium difficile infection' and further references cited within these articles.
Meta-analyses and systematic reviews have shown that CDI and rCDI risk factors are similar. Development of rCDI is attendant on many factors, including immune status or function, comorbidities and concomitant treatments. Studies suggest that poor bacterial diversity is correlated with clinical rCDI. Narrow-spectrum gut microflora-sparing antimicrobials (e.g. surotomycin, cadazolid, ridinilazole) are in development for CDI treatment, while microbiota therapeutics (faecal microbiota transplantation, nontoxigenic C. difficile, stool substitutes) are increasingly being explored. rCDI can only occur when viable C. difficile spores are present, either within the gut lumen after infection or when reacquired from the environment. C. difficile spore germination can be influenced by gut environmental factors resulting from dysbiosis, and spore outgrowth may be affected stage by some antimicrobials (e.g. fidaxomicin, ramoplanin, oritavancin).
rCDI is a significant challenge for healthcare professionals, requiring a multifaceted approach; optimized infection control to minimize reinfection; C. difficile-targeted antibiotics to minimize dysbiosis; and gut microflora restoration to promote colonization resistance. These elements should be informed by our understanding of the microbiologic factors involved in both C. difficile itself and the gut microbiome.
复发性艰难梭菌感染（rCDI）给医疗机构带来了巨大的经济和实际负担。此外，rCDI 可能会影响生活质量，使患者陷入 rCDI 循环，并依赖抗生素治疗。
讨论微生物因素在 rCDI 发展中的重要性。
文献来源于 2000 年以来 PubMed 的检索，检索词为“recurrent Clostridium difficile infection”，并进一步查阅了这些文章中的参考文献。
荟萃分析和系统评价表明，CDI 和 rCDI 的危险因素相似。rCDI 的发生与许多因素有关，包括免疫状态或功能、合并症和伴随治疗。研究表明，细菌多样性差与临床 rCDI 相关。窄谱肠道微生物群保护型抗菌药物（如苏罗替莫、卡他唑利、里迪尼唑）正在开发用于 CDI 治疗，而微生物组治疗（粪便微生物移植、非产毒艰难梭菌、粪便替代品）也越来越受到关注。只有当存在有活力的艰难梭菌孢子时，才会发生 rCDI，这些孢子可以在感染后存在于肠道腔中，也可以从环境中重新获得。艰难梭菌孢子萌发可以受到肠道环境因素的影响，这些因素是由菌群失调引起的，孢子生长可能会受到一些抗生素的影响（如非达霉素、瑞他莫林、奥他万星）。
rCDI 是医疗保健专业人员面临的重大挑战，需要采取多方面的方法；优化感染控制以尽量减少再感染；使用靶向艰难梭菌的抗生素以尽量减少菌群失调；以及恢复肠道微生物群以促进定植抵抗。这些要素应该基于我们对艰难梭菌本身和肠道微生物组中涉及的微生物因素的理解。
