Infectious Disease Department, Hospital Clinic of Barcelona, Barcelona, Spain.
Curr Opin Infect Dis. 2023 Dec 1;36(6):473-480. doi: 10.1097/QCO.0000000000000954. Epub 2023 Jul 31.
We provide an update on the recent literature on Clostridioides difficile infection (CDI) in cancer patients.
Distinguishing between colonization and infection remains challenging in cancer patients. Many patients with negative toxin analysis are still treated for CDI, and some meet criteria for severe cases. The incidence of CDI is high in cancer patients, especially those with haematological malignancies. Disruption of the gut microbiome due to antibiotic consumption, chemotherapy and radiotherapy is the primary factor contributing to CDI development. The severity of CDI in cancer patients is often unclear due to the absence of well-defined severity criteria. Certain microbiome species predominance and specific ribotypes have been associated with worse outcomes. Whole genome sequencing could be helpful for differentiating recurrence from reinfection and exploring potential nosocomial transmission. While certain new drugs such as fidaxomicin or bezlotoxumab show promise, the optimal treatment and prevention strategies for CDI in cancer patients remain uncertain. Faecal microbiota transplantation (FMT) holds potential for reducing CDI recurrence rates.
Further studies are needed to provide robust recommendations for diagnosis, grading severity, and therapeutic management of CDI in cancer patients. Recurrences are particularly concerning due to subsequent exposition to CDI risk factors.
我们就近期癌症患者艰难梭菌感染（CDI）的文献进行更新。
在癌症患者中，区分定植和感染仍然具有挑战性。许多毒素分析阴性的患者仍接受 CDI 的治疗，有些符合严重病例的标准。癌症患者 CDI 的发病率较高，尤其是血液恶性肿瘤患者。抗生素、化疗和放疗导致肠道微生物组的破坏是 CDI 发展的主要因素。由于缺乏明确的严重程度标准，癌症患者 CDI 的严重程度往往不明确。某些微生物组物种优势和特定的核糖体型与更差的结局相关。全基因组测序有助于区分复发和再感染，并探索潜在的医院内传播。虽然某些新药如非达霉素或 bezlotoxumab 显示出前景，但癌症患者 CDI 的最佳治疗和预防策略仍不确定。粪便微生物群移植（FMT）有可能降低 CDI 的复发率。
需要进一步的研究为癌症患者 CDI 的诊断、严重程度分级和治疗管理提供有力的建议。由于随后接触 CDI 的危险因素，复发尤其令人担忧。
