肝硬化难辨梭菌感染:简要综述

IF 2.7 4区 医学 Q2 Medicine
Yuanbin Liu, Mingkai Chen
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引用次数: 7

摘要

艰难梭菌是一种革兰氏阳性杆菌,经粪口传播,是目前世界范围内最常见的医院感染之一,2016年更名为艰难梭菌。艰难梭菌感染(CDI)是肝硬化中常见的感染,对预后有不良影响。本研究旨在提供具有临床实践意义的简明综述。肝硬化患者CDI患病率上升,而相关死亡率下降。多组危险因素增加肝硬化患者发生CDI的可能性,如抗生素使用、肝硬化严重程度、一些合并症和人口统计学方面。目前在最新的指南中描述了一般人群的治疗。在肝硬化患者中,由于利福昔明和乳果糖对肠道菌群的调节作用,已被证明可降低CDI风险,尽管存在相互矛盾的结果。粪便微生物群移植(FMT)作为第二次或随后CDI复发的治疗已证明在肝硬化和CDI中具有良好的安全性和有效性。需要在更多的前瞻性研究中进一步验证。目前似乎不鼓励对无症状患者进行筛查,严格的手部卫生和病房和医疗设备表面的清洁是最大限度地减少传播的基石。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clostridioides difficile Infection in Liver Cirrhosis: A Concise Review
Clostridium difficile is a Gram-positive bacillus with fecal-oral transmission and is currently one of the most common nosocomial infections worldwide, which was renamed Clostridioides difficile in 2016. Clostridioides difficile infection (CDI) is a prevalent infection in cirrhosis and negatively affects prognosis. This study aimed to provide a concise review with clinical practice implications. The prevalence of CDI in cirrhotic patients increases, while the associated mortality decreases. Multiple groups of risk factors increase the likelihood of CDI in patients with cirrhosis, such as antibiotic use, the severity of cirrhosis, some comorbidities, and demographic aspects. Treatment in the general population is currently described in the latest guidelines. In patients with cirrhosis, rifaximin and lactulose have been shown to reduce CDI risk due to their modulatory effects on the intestinal flora, although conflicting results exist. Fecal microbiota transplantation (FMT) as a treatment for the second or subsequent CDI recurrences has demonstrated a good safety and efficacy in cirrhosis and CDI. Future validation in more prospective studies is needed. Screening of asymptomatic patients appears to be discouraged for the prevention currently, with strict hand hygiene and cleaning of the ward and medical equipment surfaces being the cornerstone of minimizing transmission.
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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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