Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.
Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA; School of Medicine, St. George's University, True Blue, Grenada, The West Indies.
J Hosp Infect. 2018 Aug;99(4):436-442. doi: 10.1016/j.jhin.2018.01.015. Epub 2018 Mar 26.
The epidemiological landscape of Clostridium difficile infection (CDI) has changed over the past 30 years.
To review studies of CDI in the community setting.
Electronic databases including PubMed, MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov and Cochrane Databases were searched for human studies performed between 2000 and 2017 that assessed the epidemiology, risk factors, ribotypes, hospital and intensive care unit (ICU) outcomes, and management of community-acquired CDI. In addition, references were searched manually to identify other relevant studies.
In total, 39 articles met the inclusion criteria. The incidence of community-acquired CDI has almost doubled in the past decade. Approximately half of all cases of CDI are attributed to community origin. Individuals who are younger, female, in the presence of infants, frequently use proton pump inhibitors or specific classes of antibiotics, or live near farms and livestock are at higher risk for community-acquired CDI. Additionally, approximately 40% of all community-acquired cases require hospitalization, where severity has been linked to hypervirulent ribotypes 027 and 078 with poor outcomes. Emerging data on treatment paradigms have led to the revision of clinical guidelines and two potential vaccines in phase three clinical trials. However, ribotype-specific responses to current treatment strategies are lacking.
Community-acquired CDI represents a growing public health threat and burden on healthcare systems. A multi-disciplinary approach will be required to stem the tides.
艰难梭菌感染（CDI）的流行病学在过去 30 年中发生了变化。
综述社区环境中艰难梭菌感染的研究。
检索 2000 年至 2017 年间在PubMed、MEDLINE、Embase、Google Scholar、Scopus、ClinicalTrials.gov 和 Cochrane 数据库中进行的评估社区获得性 CDI 的流行病学、危险因素、核糖体型、医院和重症监护病房（ICU）结局以及管理的人类研究。此外，还通过手动检索参考文献来确定其他相关研究。
共有 39 篇文章符合纳入标准。过去十年中，社区获得性 CDI 的发病率几乎翻了一番。大约一半的 CDI 病例归因于社区来源。年龄较小、女性、有婴儿、经常使用质子泵抑制剂或特定类别的抗生素、或居住在农场和牲畜附近的个体患社区获得性 CDI 的风险更高。此外，大约 40%的所有社区获得性病例需要住院治疗，严重程度与高毒力核糖体型 027 和 078 相关，结局不良。关于治疗模式的新数据导致了临床指南的修订和两种处于三期临床试验阶段的潜在疫苗。然而，目前的治疗策略对核糖体型特异性反应尚不清楚。
社区获得性 CDI 是一个日益严重的公共卫生威胁，给医疗保健系统带来了沉重负担。需要采取多学科方法来遏制这一趋势。
