Ramsay Isobel, Brown Nicholas M, Enoch David A
Clinical Microbiology & Public Health Laboratory, National Infection Service, Public Health England, Addenbrooke's Hospital, Cambridge, UK.
Infect Dis (Auckl). 2018 Mar 7;11:1178633718758023. doi: 10.1177/1178633718758023. eCollection 2018.
Recurrence occurs in approximately 25% of all cases of infection (CDI) and poses a unique clinical challenge. Traditionally, treatment options of CDI have been limited to regimes of established antibiotics (eg, pulsed/tapered vancomycin) but faecal transplantation is emerging as a useful alternative. In recent years, promising new strategies have emerged for effective prevention of recurrent CDI (rCDI) including new antimicrobials (eg, fidaxomicin) and monoclonal antibodies (eg, bezlotoxumab). Despite promising progress in this area, obstacles remain for making the best use of these resources due to uncertainty over patient selection. This commentary describes the current epidemiology of rCDI, its clinical impact and risk factors, some of the measures used for treating and preventing rCDI, and some of the emerging treatment options. It then describes some of the obstacles that need to be overcome.
约25%的艰难梭菌感染（CDI）病例会复发，这带来了独特的临床挑战。传统上，CDI的治疗选择仅限于使用已有的抗生素方案（如脉冲式/递减剂量的万古霉素），但粪便移植正成为一种有效的替代方法。近年来，出现了一些有前景的新策略来有效预防复发性CDI（rCDI），包括新型抗菌药物（如非达霉素）和单克隆抗体（如贝佐妥单抗）。尽管该领域取得了令人鼓舞的进展，但由于患者选择存在不确定性，充分利用这些资源仍存在障碍。本评论描述了rCDI的当前流行病学、其临床影响和危险因素、一些用于治疗和预防rCDI的措施以及一些新出现的治疗选择。然后描述了一些需要克服的障碍。
