Centers for Disease Control and Prevention, Atlanta, Georgia.
Edward Hines Jr Veterans Administration Hospital, Hines.
Clin Infect Dis. 2018 Mar 19;66(7):e1-e48. doi: 10.1093/cid/cix1085.
A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.
由美国传染病学会(IDSA)和美国医疗保健流行病学学会(SHEA)召集的专家组更新了 2010 年关于成人艰难梭菌感染(CDI)的临床实践指南。该更新纳入了针对儿童的建议(遵循成人在流行病学、诊断和治疗方面的建议),对这种感染的管理进行了重大改变,并反映了在诊断最佳方法方面不断出现的争议。艰难梭菌仍然是医疗保健相关性腹泻的最重要原因,并且已成为美国成年人群中最常见的医疗保健相关性感染的原因。此外,艰难梭菌已确立为一种重要的社区病原体。尽管在欧洲部分地区,与整体 CDI 发生率一起,流行和毒力型 027 株的患病率显著下降,但它仍然是美国最常见的鉴定菌株之一,在美国,它导致相当一部分 CDI,尤其是医疗保健相关性 CDI。本指南更新了关于流行病学、诊断、治疗、感染预防和环境管理的建议。