Capurso Lucio, Koch Maurizio
Primario Emerito Gastroenterologia, Ospedale San Filippo Neri, Roma.
Senior Director, Unità Complessa di Gastroenterologia ed Epatologia, Ospedale San Filippo Neri, Roma.
Recenti Prog Med. 2021 Jan;112(1):42-55. doi: 10.1701/3551.35256.
Patients with IBD are at increased risk of developing Clostridium difficile (CD) infection and have worse outcomes, including higher rates of colectomy and death, and experience higher rates of recurrence. However, it is still not clear whether CD is a cause of IBD or a consequence of the inflammatory state and of intestinal dysbiosis. The association between IBD and CD may be due to different factors, such as drugs that are used for the treatment of IBD, including repeat courses of antibiotics, that might alter the intestinal flora and promote colonization, altered immune and nutritional status, frequent hospitalizations, and even genetic predisposition. It has been suggested that up to 20% of IBD flares were associated with testing positive for CD and retrospective studies demonstrated doubling of the infection incidence among patients with Crohn Disease, and a 3-fold increase among those with Ulcerative Colitis. They have also shown that the CD infection incidence among IBD patients is estimated as being 3-fold higher than that in the general population. Decreased intestinal microbial diversity along with an inadequate immune response is thought to play a causative role in the development of CD infection.
炎症性肠病（IBD）患者发生艰难梭菌（CD）感染的风险增加，且预后较差，包括更高的结肠切除术率和死亡率，以及更高的复发率。然而，CD是IBD的病因还是炎症状态和肠道生态失调的结果仍不清楚。IBD与CD之间的关联可能归因于不同因素，如用于治疗IBD的药物，包括重复使用抗生素疗程，这可能会改变肠道菌群并促进其定植，免疫和营养状况改变、频繁住院，甚至遗传易感性。有人提出，高达20%的IBD发作与CD检测呈阳性有关，回顾性研究表明，克罗恩病患者的感染发生率翻倍，溃疡性结肠炎患者的感染发生率增加了两倍。这些研究还表明，IBD患者中的CD感染发生率估计比普通人群高3倍。肠道微生物多样性降低以及免疫反应不足被认为在CD感染的发生中起因果作用。
