McFarland Lynne V, Goldstein Ellie J C, Kullar Ravina
McFarland Consulting, Seattle, WA 98115, USA.
R.M. Alden Research Laboratory, Santa Monica, CA 90404, USA.
Microorganisms. 2023 Jun 9;11(6):1534. doi: 10.3390/microorganisms11061534.
infections (CDIs) have decreased in the past years, but since 2021, some hospitals have reported an increase in CDI rates. CDI remains a global concern and has been identified as an urgent threat to healthcare. Although multiple treatment options are available, prevention strategies are more limited. As CDI is an opportunistic infection that arises after the normally protective microbiome has been disrupted, preventive measures aimed at restoring the microbiome have been tested. Our aim is to update the present knowledge on these various preventive strategies published in the past five years (2018-2023) to guide clinicians and healthcare systems on how to best prevent CDI. A literature search was conducted using databases (PubMed, Google Scholar, and clinicaltrials.gov) for phase 2-3 clinical trials for the primary or secondary prevention of CDI and microbiome and probiotics. As the main factor for infections is the disruption of the normally protective intestinal microbiome, strategies aimed at restoring the microbiome seem most rational. Some strains of probiotics, the use of fecal microbial therapy, and live biotherapeutic products offer promise to fill this niche; although, more large randomized controlled trials are needed that document the shifts in the microbiome population.
艰难梭菌感染（CDIs）在过去几年有所下降，但自2021年以来，一些医院报告CDI发生率有所上升。CDI仍然是一个全球关注的问题，并已被确定为对医疗保健的紧迫威胁。尽管有多种治疗选择，但预防策略更为有限。由于CDI是一种在正常保护性微生物群被破坏后出现的机会性感染，旨在恢复微生物群的预防措施已经过测试。我们的目的是更新过去五年（2018 - 2023年）发表的关于这些各种预防策略的现有知识，以指导临床医生和医疗系统如何最好地预防CDI。使用数据库（PubMed、谷歌学术和clinicaltrials.gov）进行文献检索，以查找关于CDI以及微生物群和益生菌的一级或二级预防的2 - 3期临床试验。由于艰难梭菌感染的主要因素是正常保护性肠道微生物群的破坏，旨在恢复微生物群的策略似乎最为合理。一些益生菌菌株、粪便微生物疗法的使用以及活生物治疗产品有望填补这一空白；尽管如此，还需要更多大型随机对照试验来记录微生物群数量的变化。
