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艰难梭菌感染:发病机制、临床考量及治疗策略的临床综述

Clostridioides difficile Infection: A Clinical Review of Pathogenesis, Clinical Considerations, and Treatment Strategies.

作者信息

Sinnathamby Evan S, Mason Joseph W, Flanagan Chelsi J, Pearl Nathan Z, Burroughs Caroline R, De Witt Audrey J, Wenger Danielle M, Klapper Vincent G, Ahmadzadeh Shahab, Varrassi Giustino, Shekoohi Sahar, Kaye Alan D

机构信息

School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA.

School of Medicine, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA.

出版信息

Cureus. 2023 Dec 27;15(12):e51167. doi: 10.7759/cureus.51167. eCollection 2023 Dec.

Abstract

BACKGROUND

infection (CDI) is a common nosocomial infection. Risk factors for developing CDI include prior hospitalization, being older than 65 years old, antibiotic use, and chronic disease. It is linked with diarrhea and colitis and can vary in severity. It is a major cause of increased morbidity and mortality among hospitalized patients. However, community-acquired CDI is also increasing. Proper diagnosis and determination of severity are crucial for the treatment of CDI. Depending on how severe the CDI is, the patient may endorse different symptoms and physical exam findings. The severity of CDI will determine how aggressively it is treated. Management and treatment: Laboratory studies can be helpful in the diagnosis of CDI. In this regard, common labs include complete blood count, stool assays, and, in certain cases, radiography and endoscopy. Mild-to-moderate colitis is treated with antibiotics, but severe colitis requires a different approach, which may include surgery. Several alternative therapies for CDI exist and have shown promising results. This review will touch upon these therapies, which include fecal transplants, intravenous immunoglobulin, and the use of cholestyramine and tigecycline.

CONCLUSION

Prevention of CDI can be achieved by proper hygiene, vaccinations, and detecting the infection early. Proper hygiene is indeed noted to be one of the best ways to prevent CDI in the hospital setting. Overprescribing antibiotics is also another huge reason why CDI occurs. Proper prescription of antibiotics can also help reduce the chances of acquiring CDI.

摘要

背景

艰难梭菌感染(CDI)是一种常见的医院感染。发生CDI的风险因素包括既往住院史、年龄超过65岁、使用抗生素以及患有慢性病。它与腹泻和结肠炎有关,严重程度各异。它是住院患者发病率和死亡率增加的主要原因。然而,社区获得性CDI也在增加。正确诊断和确定严重程度对于CDI的治疗至关重要。根据CDI的严重程度,患者可能会出现不同的症状和体格检查结果。CDI的严重程度将决定治疗的积极程度。管理与治疗:实验室检查有助于CDI的诊断。在这方面,常见的检查包括全血细胞计数、粪便检测,在某些情况下还包括放射检查和内镜检查。轻度至中度结肠炎用抗生素治疗,但重度结肠炎需要不同的方法,可能包括手术。存在几种针对CDI的替代疗法,并已显示出有前景的结果。本综述将涉及这些疗法,包括粪便移植、静脉注射免疫球蛋白以及使用考来烯胺和替加环素。

结论

通过适当的卫生措施、接种疫苗以及早期检测感染可以预防CDI。在医院环境中,适当的卫生措施确实被认为是预防CDI的最佳方法之一。抗生素过度处方也是CDI发生的另一个重要原因。合理使用抗生素也有助于减少获得CDI的机会。

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