Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
Department PROMISE-Infectious and Tropical Diseases Unit, AOU Policlinico "P. Giaccone", University of Palermo, 90127 Palermo, Italy.
J Antimicrob Chemother. 2024 Sep 3;79(9):2103-2118. doi: 10.1093/jac/dkae179.
Clostridioides difficile infection (CDI), a leading cause of nosocomial deaths, is a microbiota-mediated disease. As such, the use of broader spectrum antibiotics, such as vancomycin and metronidazole, can prime the gastrointestinal tract to become more prone to CDI recurrences. Fidaxomicin, a narrow-spectrum antibiotic, has been demonstrated to be superior in preventing recurrence and in preserving the intestinal microbiota; however, widespread employment worldwide has been hindered due to high acquisition costs.
To integrate the currently available guidelines on the management of CDI and to shed light on the timeliest employment of fidaxomicin.
An expert panel was gathered to obtain consensus using Delphi methodology on a series of statements regarding the management of CDI and on appropriate antibiotic use.
Consensus was reached on 21 of the 25 statements addressing the management of CDI.
Delphi methodology was used to achieve consensus on the management of CDI, on the identification of patients at risk of recurrences or severe infection, and on the most appropriate use of fidaxomicin, with the final aim of fostering clinical practice application of treatment algorithms proposed by previous guidelines, in absolute synergy. It could be an important tool to promote more appropriate and cost-effective CDI treatments in European settings with limited resources, like Italy.
艰难梭菌感染（CDI）是医院内死亡的主要原因之一，是一种由微生物群介导的疾病。因此，使用更广泛的抗生素，如万古霉素和甲硝唑，会使胃肠道更容易复发 CDI。窄谱抗生素菲达霉素已被证明在预防复发和维持肠道微生物群方面更有效；然而，由于高收购成本，其在全球范围内的广泛应用受到了阻碍。
整合目前关于 CDI 管理的指南，并阐明菲达霉素的最佳使用时机。
召集一个专家小组，使用 Delphi 方法就一系列关于 CDI 管理和适当抗生素使用的陈述达成共识。
就 25 项关于 CDI 管理的陈述中的 21 项达成了共识。
Delphi 方法用于就 CDI 的管理、识别有复发或严重感染风险的患者以及最适当使用菲达霉素达成共识，最终目标是促进以前指南提出的治疗算法在临床实践中的应用，以实现绝对协同。对于意大利等资源有限的欧洲环境，它可能是促进更适当和更具成本效益的 CDI 治疗的重要工具。
