Boton Noah, Patel Payal K, Beekmann Susan E, Polgreen Philip M, Buckel Whitney R, Mahoney Monica V, Mehrotra Preeti, Lee Matthew S L
Division of Infectious Diseases and Immunology, NYU Langone Health, New York, New York, USA.
Division of Infectious Diseases, Intermountain Health, Salt Lake City, Utah, USA.
Open Forum Infect Dis. 2025 Jun 17;12(7):ofaf335. doi: 10.1093/ofid/ofaf335. eCollection 2025 Jul.
The 2021 Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) guidelines for infection (CDI) introduced new recommendations for managing initial and recurrent CDI. Since then, new microbiome-based therapies for preventing recurrent CDI have become available. We surveyed infectious diseases (ID) clinicians to understand their experiences, practices, and challenges in CDI management.
An electronic survey was distributed to members of the IDSA Emerging Infections Network in May 2024, targeting ID physicians and healthcare professionals in the United States who manage adult CDI. The survey assessed treatment preferences, clinical practices, and barriers to accessing and prescribing CDI therapies.
Of the 500 respondents who reported treating CDI in the past year, 83% (417/500) indicated that vancomycin was their most frequently prescribed agent for initial, nonfulminant CDI. Additionally, 72% (357/498) reported that their institutional guidelines recommended vancomycin as the first-line agent. The most common barrier to fidaxomicin use was challenges with outpatient insurance coverage (82% [408/496]). Bezlotoxumab was available to 74% (370/500) of respondents, though 33% (165/497) indicated they do not use bezlotoxumab routinely. Most clinicians (87% [437/500]) had previously recommended fecal microbiota transplantation (FMT) for recurrent CDI, though only 48% (239/500) had current access to FMT using donor stool. Fecal microbiota live-jslm was available to 36% (179/500), and fecal microbiota spores live-brpk was available to 30% (150/500).
Significant barriers, including high costs, insurance challenges, and limited availability of CDI therapies, impact clinical decision-making and adherence to guideline recommendations.
美国传染病学会（IDSA）和美国医疗保健流行病学学会（SHEA）发布的2021年艰难梭菌感染（CDI）指南针对初发性和复发性CDI的管理提出了新建议。自那时以来，出现了新的基于微生物群的预防复发性CDI的疗法。我们对传染病（ID）临床医生进行了调查，以了解他们在CDI管理方面的经验、做法和挑战。
2024年5月，向IDSA新发感染网络的成员发放了一份电子调查问卷，目标是美国管理成人CDI的ID医生和医疗保健专业人员。该调查评估了治疗偏好、临床实践以及获取和开具CDI疗法的障碍。
在过去一年中报告治疗过CDI的500名受访者中，83%（417/500）表示万古霉素是他们治疗初发性、非暴发性CDI时最常开具的药物。此外，72%（357/498）报告称他们机构的指南推荐万古霉素作为一线药物。使用非达霉素的最常见障碍是门诊保险覆盖方面的问题（82%[408/496]）。74%（370/500）的受访者可以使用贝佐托昔单抗，不过33%（165/497）表示他们不常规使用贝佐托昔单抗。大多数临床医生（87%[437/500]）此前曾推荐粪便微生物群移植（FMT）用于复发性CDI，不过目前只有48%（239/500）能够获取使用供体粪便的FMT。36%（179/500）的受访者可以使用活的粪便微生物群制剂live-jslm，30%（150/500）的受访者可以使用活的粪便微生物群孢子制剂live-brpk。
包括高成本、保险问题以及CDI疗法供应有限等重大障碍，影响了临床决策和对指南建议的遵循。
