Chaar Abdelkader, Feuerstadt Paul
Section of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA.
Division of Digestive Diseases, Yale University School of Medicine, PACT-Gastroenterology Center, 2200 Whitney Avenue, Hamden, CT 06518, USA.
Therap Adv Gastroenterol. 2021 May 7;14:17562848211011953. doi: 10.1177/17562848211011953. eCollection 2021.
infection (CDI) has been an epidemic for many years. Our biggest challenge in treating CDI is preventing recurrence, which is seen in approximately 25% of patients with initial infection and in 40-60% of those with subsequent episodes. Given the major disease burden of this infection, appropriate data-driven treatment remains essential. Clinical treatment guidelines provide an unbiased critical analysis of the literature, integrating the quality of the available data to make recommendations. As CDI has been evolving and more research has become available, the frequency of guideline issue from various global societies has increased, as has the detail of the recommendations to fit more relevant clinical scenarios. In this review, we will discuss clinical guideline recommendations over three time periods: The Initial Guidelines 1995-1997, The Second Wave 2009-2013, and The Modern Era 2014-present. We see the changing recommendations from metronidazole or vancomycin for initial infection during earlier times to preferential treatment with fidaxomicin within the Infectious Diseases Society of America (IDSA) and Society of Healthcare Epidemiology of America (SHEA) joint guidelines provisional update in late 2020. The recommended treatments for first recurrence were initially with the same antimicrobial as the first episode but have since changed to having multiple options for one or more recurrences. We have also seen the addition of immune boosting treatments, including fecal microbiota transplantation (FMT)/microbiota restoration therapy (MRT) and bezlotoxumab in the more modern recommendations. As the guidelines are evolving with the times, it remains important to understand the differences among them so we can apply this information clinically and optimize patient outcomes.
艰难梭菌感染（CDI）多年来一直是一种流行病。我们在治疗CDI方面面临的最大挑战是预防复发，约25%的初始感染患者以及40%-60%的后续发作患者会出现复发情况。鉴于这种感染带来的重大疾病负担，恰当的数据驱动型治疗仍然至关重要。临床治疗指南对文献进行无偏见的批判性分析，整合现有数据的质量以提出建议。随着CDI不断演变且有更多研究问世，全球各学会发布指南的频率增加了，建议的细节也更贴合相关临床场景。在本综述中，我们将讨论三个时间段的临床指南建议：1995 - 1997年的初始指南、2009 - 2013年的第二波指南以及2014年至今的现代指南。我们看到，从早期初始感染使用甲硝唑或万古霉素的建议，到2020年末美国传染病学会（IDSA）和美国医疗保健流行病学学会（SHEA）联合指南临时更新中优先使用非达霉素进行治疗，建议发生了变化。首次复发的推荐治疗最初与首次发作使用相同的抗菌药物，但此后已转变为针对一次或多次复发有多种选择。我们还看到在更现代的建议中增加了免疫增强治疗，包括粪便微生物群移植（FMT）/微生物群恢复疗法（MRT）和贝佐托单抗。随着指南与时俱进地发展，了解它们之间的差异仍然很重要，这样我们才能在临床上应用这些信息并优化患者的治疗效果。
