艰难梭菌复发性感染的微生物群恢复。

IF 4.3 4区 医学 0 MEDICINE, GENERAL & INTERNAL
Sahil Khanna
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引用次数: 0

摘要

自近期北美和欧洲发布艰难梭菌感染(CDI)管理指南以来,关于艰难梭菌感染流行病学、检测和治疗的新证据不断涌现。尽管在感染控制和抗生素管理方面取得了诸多进步,但医院和社区的 CDI 发病率和负担仍然居高不下。除了原发性 CDI 的发病率,复发性 CDI 的发病率也居高不下。由于 PCR 的灵敏度较高(导致假阳性),而 EIA 对毒素的灵敏度有限,因此原发性和复发性 CDI 的检测仍然是一项临床挑战。复发性 CDI 的病理生理学涉及感染和 CDI 治疗导致的微生物群持续紊乱。万古霉素等广谱抗生素会进一步破坏微生物区系,而菲达霉素对微生物区系的破坏较小,复发率较低。基于这些数据,菲达霉素被认为是治疗复发性CDI的一线抗生素。静脉注射贝洛妥珠单抗是一种单克隆抗体,可降低高危患者的复发风险,但不能恢复微生物群。实验性粪便微生物群移植(FMT)已问世十多年。由于粪便微生物群移植的成功,自 2022 年底以来,两种新的非侵入性、依赖于供体的、经美国食品和药物管理局(FDA)批准的疗法已经问世。本综述总结了所有这些与 CDI 相关的难题,并提供了可在日常实践中使用的临床宝典。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Microbiota restoration for recurrent Clostridioides difficile infection.

Since the publication of the recent North American and European guidelines on management of Clostridioides difficile infection (CDI), new evidence describing the epidemiology, testing and treatment of CDI has emerged. Despite all advances in infection control and antibiotic stewardship, the incidence and burden of CDI in the hospitals and the community remains at a stable high. Coupled with the incidence of primary CDI, there is a stable high incidence of recurrent CDI. Testing for primary and recurrent CDI remains a clinical challenge owing to high sensitivity of the PCR (leading to false positives) and somewhat limited sensitivity of EIA for toxin. The pathophysiology of recurrent CDI involves an ongoing disruption of the microbiota owing to the infection and the treatment of CDI employed. Broad spectrum antibiotics such as vancomycin leads to further disruption of microbiota compared to fidaxomicin which has a lower disruption of the microbiota and leads to fewer recurrences. Owing to these data fidaxomicin is considered as the first line antibiotic for recurrent CDI. Intravenous bezlotoxumab is a monoclonal antibody that reduces the risk of recurrence in high-risk patients but does not restore the microbiota. Experimental fecal microbiota transplantation (FMT) has been available for more than a decade. Owing to the success of FMT, two new non-invasive donor dependent Food and Drug Administration (FDA) approved therapies have been available since late 2022. This review summarizes all these conundrums regarding CDI and provides clinical pearls to use in day-to-day practice.

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来源期刊
Panminerva medica
Panminerva medica 医学-医学:内科
CiteScore
5.00
自引率
2.30%
发文量
199
审稿时长
>12 weeks
期刊介绍: Panminerva Medica publishes scientific papers on internal medicine. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).
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