Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
French Group of Faecal Microbiota Transplantation.
BMJ. 2019 Aug 20;366:l4609. doi: 10.1136/bmj.l4609.
(formerly ) is a major cause of healthcare associated diarrhea, and is increasingly present in the community. Historically, infection was considered easy to diagnose and treat. Over the past two decades, however, diagnostic techniques have changed in line with a greater understanding of the physiopathology of infection and the use of new therapeutic molecules. The evolution of diagnosis showed there was an important under- and misdiagnosis of infection, emphasizing the importance of algorithms recommended by European and North American infectious diseases societies to obtain a reliable diagnosis. Previously, metronidazole was considered the reference drug to treat infection, but more recently vancomycin and other newer drugs are shown to have higher cure rates. Recurrence of infection represents a key parameter in the evaluation of new drugs, and the challenge is to target the right population with the adapted therapeutic molecule. In multiple recurrences, fecal microbiota transplantation is recommended. New approaches, including antibodies, vaccines, and new molecules are already available or in the pipeline, but more data are needed to support the inclusion of these in practice guidelines. This review aims to provide a baseline for clinicians to understand and stratify their choice in the diagnosis and treatment of infection based on the most recent data available.
(以前)是导致医疗保健相关腹泻的主要原因,并且在社区中越来越普遍。历史上, 感染被认为易于诊断和治疗。然而,在过去的二十年中,随着对 感染病理生理学的理解不断加深以及新型治疗药物的应用,诊断技术也发生了变化。诊断方法的演变表明, 感染的漏诊和误诊情况非常严重,这强调了采用欧洲和北美传染病学会推荐的算法以获得可靠诊断的重要性。以前,甲硝唑被认为是治疗 感染的参考药物,但最近发现万古霉素和其他新型药物具有更高的治愈率。感染的复发是评估新药的关键参数,其挑战在于针对具有适应治疗药物的目标人群。对于多次复发的患者,建议进行粪便微生物移植。新的治疗方法,包括抗体、疫苗和新型药物已经可用或正在研发中,但还需要更多的数据来支持将这些方法纳入实践指南。本综述旨在为临床医生提供一个基础,以根据最新的可用数据来理解和分层他们在诊断和治疗 感染方面的选择。