复发性感染有效预防与治疗的最新进展
Recent Progress for the Effective Prevention and Treatment of Recurrent Infection.
作者信息
Ramsay Isobel, Brown Nicholas M, Enoch David A
机构信息
Clinical Microbiology & Public Health Laboratory, National Infection Service, Public Health England, Addenbrooke's Hospital, Cambridge, UK.
出版信息
Infect Dis (Auckl). 2018 Mar 7;11:1178633718758023. doi: 10.1177/1178633718758023. eCollection 2018.
Abstract
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.
摘要
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。
相似文献
1
Recent Progress for the Effective Prevention and Treatment of Recurrent Infection.复发性感染有效预防与治疗的最新进展
Infect Dis (Auckl). 2018 Mar 7;11:1178633718758023. doi: 10.1177/1178633718758023. eCollection 2018.
2
Doctor, my patient has CDI and should continue to receive antibiotics. The (unresolved) risk of recurrent CDI.医生，我的患者患有艰难梭菌感染（CDI），应该继续接受抗生素治疗。存在复发性艰难梭菌感染的（未解决的）风险。
Rev Esp Quimioter. 2019 Sep;32 Suppl 2(Suppl 2):47-54.
3
Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection in Patients at Increased Risk for Recurrence.贝洛妥珠单抗预防高复发风险的复发性艰难梭菌感染。
Clin Infect Dis. 2018 Aug 16;67(5):649-656. doi: 10.1093/cid/ciy171.
4
Efficacy of Bezlotoxumab in Participants Receiving Metronidazole, Vancomycin, or Fidaxomicin for Treatment of () Infection.贝佐妥昔单抗在接受甲硝唑、万古霉素或非达霉素治疗（）感染的参与者中的疗效。
Open Forum Infect Dis. 2020 Jun 2;7(6):ofaa157. doi: 10.1093/ofid/ofaa157. eCollection 2020 Jun.
5
Bezlotoxumab: anti-toxin B monoclonal antibody to prevent recurrence of Clostridium difficile infection.贝左妥珠单抗：抗毒素 B 单克隆抗体，用于预防艰难梭菌感染复发。
Expert Rev Gastroenterol Hepatol. 2017 Jul;11(7):611-622. doi: 10.1080/17474124.2017.1344551. Epub 2017 Jun 26.
6
Recurrent Infection: Risk Factors, Treatment, and Prevention.反复感染：危险因素、治疗和预防。
Gut Liver. 2019 Jan 15;13(1):16-24. doi: 10.5009/gnl18071.
7
Bezlotoxumab Therapy for Recurrent Infection in an Ulcerative Colitis Patient.贝佐妥单抗治疗溃疡性结肠炎患者复发性感染
Crohns Colitis 360. 2022 Nov 2;4(3):otac038. doi: 10.1093/crocol/otac038. eCollection 2022 Jul.
8
The Monoclonal Antitoxin Antibodies (Actoxumab-Bezlotoxumab) Treatment Facilitates Normalization of the Gut Microbiota of Mice with Infection.单克隆抗毒素抗体（Actoxumab-Bezlotoxumab）治疗有助于感染小鼠肠道微生物群的正常化。
Front Cell Infect Microbiol. 2016 Oct 4;6:119. doi: 10.3389/fcimb.2016.00119. eCollection 2016.
9
Microbiologic factors affecting Clostridium difficile recurrence.影响艰难梭菌复发的微生物因素。
Clin Microbiol Infect. 2018 May;24(5):476-482. doi: 10.1016/j.cmi.2017.11.017. Epub 2017 Dec 5.
10
Bezlotoxumab for Preventing Recurrent Clostridioides difficile Infection: A Narrative Review from Pathophysiology to Clinical Studies.贝佐妥昔单抗预防艰难梭菌反复感染：从病理生理学到临床研究的叙述性综述
Infect Dis Ther. 2020 Sep;9(3):481-494. doi: 10.1007/s40121-020-00314-5. Epub 2020 Jul 6.
引用本文的文献
1
Assessment of chemical methods in the extraction of spore surface layers in spores.评估用于提取孢子中孢子表面层的化学方法。
bioRxiv. 2025 Aug 19:2025.08.19.671018. doi: 10.1101/2025.08.19.671018.
2
Using a ligate intestinal loop mouse model to investigate Clostridioides difficile adherence to the intestinal mucosa in aged mice.采用结扎肠袢小鼠模型研究艰难梭菌在老年小鼠肠道黏膜的黏附作用。
PLoS One. 2021 Dec 22;16(12):e0261081. doi: 10.1371/journal.pone.0261081. eCollection 2021.
3
Anti-toxin antibody is not associated with recurrent Clostridium difficile infection.抗毒素抗体与复发性艰难梭菌感染无关。
Anaerobe. 2021 Feb;67:102299. doi: 10.1016/j.anaerobe.2020.102299. Epub 2020 Nov 21.
4
Gastrointestinal Microbiome - What We Need to Know in Clinical Practice.胃肠道微生物群——临床实践中我们需要了解的内容。
GE Port J Gastroenterol. 2020 Aug;27(5):336-351. doi: 10.1159/000505036. Epub 2020 Jan 14.
5
Insights into the Role of Human Gut Microbiota in Infection.深入了解人类肠道微生物群在感染中的作用。
Microorganisms. 2020 Jan 31;8(2):200. doi: 10.3390/microorganisms8020200.
6
Doctor, my patient has CDI and should continue to receive antibiotics. The (unresolved) risk of recurrent CDI.医生，我的患者患有艰难梭菌感染（CDI），应该继续接受抗生素治疗。存在复发性艰难梭菌感染的（未解决的）风险。
Rev Esp Quimioter. 2019 Sep;32 Suppl 2(Suppl 2):47-54.
7
Update in Infectious Diseases 2019.2019年传染病学最新进展
Rev Esp Quimioter. 2019 Sep;32 Suppl 2(Suppl 2):1-9.
本文引用的文献
1
Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial.延长脉冲 fidaxomicin 与万古霉素治疗 60 岁及以上患者艰难梭菌感染（EXTEND）：一项随机、对照、开放性标签、3b/4 期试验。
Lancet Infect Dis. 2018 Mar;18(3):296-307. doi: 10.1016/S1473-3099(17)30751-X. Epub 2017 Dec 19.
2
Prediction of Recurrent Clostridium Difficile Infection Using Comprehensive Electronic Medical Records in an Integrated Healthcare Delivery System.在综合医疗服务系统中使用全面电子病历预测复发性艰难梭菌感染。
Infect Control Hosp Epidemiol. 2017 Oct;38(10):1196-1203. doi: 10.1017/ice.2017.176. Epub 2017 Aug 24.
3
Increasing Incidence of Multiply Recurrent Clostridium difficile Infection in the United States: A Cohort Study.美国多重复发艰难梭菌感染发病率的增加：一项队列研究。
Ann Intern Med. 2017 Aug 1;167(3):152-158. doi: 10.7326/M16-2733. Epub 2017 Jul 4.
4
Association of Gastric Acid Suppression With Recurrent Clostridium difficile Infection: A Systematic Review and Meta-analysis.胃酸抑制与艰难梭菌反复感染的关联：一项系统评价和荟萃分析。
JAMA Intern Med. 2017 Jun 1;177(6):784-791. doi: 10.1001/jamainternmed.2017.0212.
5
Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection.万古霉素与甲硝唑预防艰难梭菌感染患者复发和死亡的疗效比较。
JAMA Intern Med. 2017 Apr 1;177(4):546-553. doi: 10.1001/jamainternmed.2016.9045.
6
Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection.贝洛妥珠单抗预防复发性艰难梭菌感染。
N Engl J Med. 2017 Jan 26;376(4):305-317. doi: 10.1056/NEJMoa1602615.
7
Oral Vancomycin Followed by Fecal Transplantation Versus Tapering Oral Vancomycin Treatment for Recurrent Clostridium difficile Infection: An Open-Label, Randomized Controlled Trial.口服万古霉素序贯粪便移植与逐渐减少口服万古霉素治疗复发性艰难梭菌感染：一项开放标签、随机对照试验。
Clin Infect Dis. 2017 Feb 1;64(3):265-271. doi: 10.1093/cid/ciw731. Epub 2016 Nov 9.
8
Epidemiology and Recurrence Rates of Clostridium difficile Infections in Germany: A Secondary Data Analysis.德国艰难梭菌感染的流行病学及复发率：一项二次数据分析
Infect Dis Ther. 2016 Dec;5(4):545-554. doi: 10.1007/s40121-016-0135-9. Epub 2016 Oct 21.
9
Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study.复发性艰难梭菌感染成人的医疗服务利用情况：一项基于人群的12年研究
Infect Control Hosp Epidemiol. 2017 Jan;38(1):45-52. doi: 10.1017/ice.2016.232. Epub 2016 Oct 20.
10
A Novel Microbiome Therapeutic Increases Gut Microbial Diversity and Prevents Recurrent Clostridium difficile Infection.一种新型微生物组治疗药物可增加肠道微生物多样性，预防复发性艰难梭菌感染。
J Infect Dis. 2016 Jul 15;214(2):173-81. doi: 10.1093/infdis/jiv766. Epub 2016 Feb 8.
Zotero 插件