Trunfio Mattia, Scabini Silvia, Rugge Walter, Bonora Stefano, Di Perri Giovanni, Calcagno Andrea
Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, 10149 Torino, Italy.
Unit of Infectious Diseases, AOU "Città della Salute e della Scienza", Department of Medical Sciences, University of Turin, 10149 Torino, Italy.
Microorganisms. 2022 Jun 23;10(7):1275. doi: 10.3390/microorganisms10071275.
We narratively reviewed the physiopathology, epidemiology, and management of co-infections in colitis (CDI) by searching the following keywords in Embase, MedLine, and PubMed: "", "co-infection", "blood-stream infection" (BSI), "fungemia", "", "", "probiotics", "microbial translocation" (MT). Bacterial BSIs (mainly by and ) and fungemia (mainly by ) may occur in up to 20% and 9% of CDI, increasing mortality and length of hospitalization. Up to 68% of the isolates are multi-drug-resistant bacteria. A pivotal role is played by gut dysbiosis, intestinal barrier leakage, and MT. Specific risk factors are represented by CDI-inducing broad-spectrum antibiotics, oral vancomycin use, and CDI severity. Probiotics administration (mainly and ) during moderate/severe CDI may favor probiotics superinfection. Other co-infections (such as or protozoa) can complicate limited and specific cases. There is mounting evidence that fidaxomicin, bezlotoxumab, and fecal microbiota transplantation can significantly reduce the rate of co-infections compared to historical therapies by interrupting the vicious circle between CDI, treatments, and MT. Bacterial BSIs and candidemia represent the most common co-infections in CDI. Physicians should be aware of this complication to promptly diagnose and treat it and enforce preventive strategies that include a more comprehensive consideration of newer treatment options.
我们通过在Embase、MedLine和PubMed中搜索以下关键词，对结肠炎合并感染（CDI）的生理病理学、流行病学和管理进行了叙述性综述：“”、“合并感染”、“血流感染”（BSI）、“真菌血症”、“”、“”、“益生菌”、“微生物易位”（MT）。细菌性血流感染（主要由和引起）和真菌血症（主要由引起）在高达20%和9%的CDI患者中可能发生，会增加死亡率和住院时间。高达68%的分离株为多重耐药菌。肠道生态失调、肠屏障渗漏和微生物易位起着关键作用。特定的危险因素包括诱导CDI的广谱抗生素、口服万古霉素的使用以及CDI的严重程度。在中度/重度CDI期间给予益生菌（主要是和）可能会促进益生菌的二重感染。其他合并感染（如或原生动物）可使有限的特定病例复杂化。越来越多的证据表明，与传统疗法相比，非达霉素、贝佐妥单抗和粪便微生物群移植通过中断CDI、治疗和微生物易位之间的恶性循环，可显著降低合并感染的发生率。细菌性血流感染和念珠菌血症是CDI中最常见的合并感染。医生应意识到这种并发症，以便及时诊断和治疗，并实施预防策略，包括更全面地考虑更新的治疗选择。
