Salvati Federica, Catania Francesca, Murri Rita, Fantoni Massimo, Torti Carlo
Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
Infez Med. 2024 Sep 1;32(3):280-291. doi: 10.53854/liim-3203-3. eCollection 2024.
(C. difficile) is a Gram-positive, spore-forming anaerobic bacterium emerged as a leading cause of diarrhea globally. CDI's ( infection) impact on healthcare systems is concerning due to high treatment cost and increased hospitalisation time. The incidence of CDI has been influenced by hypervirulent strains such as the 027 ribotype, responsible for significant outbreaks in North America and Europe. CDI's epidemiology has evolved, showing increased community-acquired cases alongside traditional hospital-acquired infections. Mortality rates remain high, with recurrent infections further elevating the risk. Transmission of primarily occurs via spores, which survive in healthcare settings and play a pivotal role in transmission. Not only health workers, but also the food chain could have a significant impact on the transmission of infection, although no confirmed foodborne cases have been documented. Pathogenicity of involves spore germination and toxin production. Toxins A and B can cause cellular damage and inflammatory responses in the host, leading to colitis. Clinical picture can range from mild diarrhea to fulminant colitis with toxic megacolon, and bowel perforation. Risk factors for CDI include antibiotic exposure, advanced age, hospitalization, and use of proton pump inhibitors. Patients who experience abdominal surgery or patients with inflammatory bowel disease (IBD) are particularly susceptible due to their compromised gut microbiota. Management of CDI has evolved, with fidaxomicin emerging as a superior treatment option over vancomycin for initial and recurrent infections due to its reduction of recurrence rate. Faecal microbiota transplantation (FMT) is effective for recurrent CDI, restoring gut eubiosis. Bezlotoxumab, a monoclonal antibody against toxin B, has shown promise in reducing recurrence rates. Severe cases of CDI may require surgical intervention, particularly in instances of toxic megacolon or bowel perforation. In conclusion, CDI remains a significant clinical entity. Further research are needed to improve patients' outcome and reduce the burden on healthcare systems.
艰难梭菌是一种革兰氏阳性、形成芽孢的厌氧菌，已成为全球腹泻的主要病因。艰难梭菌感染对医疗系统的影响令人担忧，因为治疗成本高昂且住院时间延长。027 核糖体分型等高毒力菌株影响了艰难梭菌感染的发病率，这些菌株在北美和欧洲引发了重大疫情。艰难梭菌感染的流行病学情况已经演变，社区获得性病例与传统医院获得性感染病例都在增加。死亡率仍然很高，复发性感染进一步增加了风险。艰难梭菌主要通过芽孢传播，芽孢在医疗环境中存活并在传播中起关键作用。不仅医护人员，而且食物链也可能对感染传播产生重大影响，尽管尚未记录到确诊的食源性病例。艰难梭菌的致病性涉及芽孢萌发和毒素产生。毒素 A 和毒素 B 可导致宿主细胞损伤和炎症反应，进而引发结肠炎。临床表现范围从轻度腹泻到伴有中毒性巨结肠和肠穿孔的暴发性结肠炎。艰难梭菌感染的风险因素包括抗生素暴露、高龄、住院以及使用质子泵抑制剂。经历腹部手术的患者或患有炎症性肠病（IBD）的患者由于肠道微生物群受损而特别易感。艰难梭菌感染的治疗方法已经演变，非达霉素由于降低了复发率，已成为比万古霉素更优的初始和复发性感染治疗选择。粪便微生物群移植（FMT）对复发性艰难梭菌感染有效，可恢复肠道微生态平衡。贝佐妥单抗是一种抗毒素 B 的单克隆抗体，已显示出降低复发率的前景。严重的艰难梭菌感染病例可能需要手术干预，特别是在出现中毒性巨结肠或肠穿孔的情况下。总之，艰难梭菌感染仍然是一个重要的临床问题。需要进一步研究以改善患者预后并减轻医疗系统的负担。
