Epidemiology, diagnosis and treatment of Clostridium difficile infection

被引:1
作者
Bassetti, Matteo [1 ]
Villa, Giovanni [1 ]
Pecori, Davide [1 ]
Arzese, Alessandra [2 ]
Wilcox, Mark [3 ,4 ]
机构
[1] Santa Maria Misericordia Univ Hosp, Div Infect Dis, Udine, Italy
[2] Univ Udine, Dept Expt Clin Med, I-33100 Udine, Italy
[3] Leeds Teaching Hosp, Dept Microbiol, Leeds, W Yorkshire, England
[4] Univ Leeds, Leeds, W Yorkshire, England
关键词
Clostridium difficile; diagnosis; diarrhea; epidemiology; fidaxomicin; metronidazole; treatment; vancomycin; POLYMERASE-CHAIN-REACTION; FRAGMENT LENGTH POLYMORPHISM; TRIOSE PHOSPHATE ISOMERASE; PROTON PUMP INHIBITORS; TOXIN-A; DOUBLE-BLIND; GLUTAMATE-DEHYDROGENASE; HOSPITALIZED-PATIENTS; STOOL SAMPLES; RISK-FACTORS;
D O I
10.1586/ERI.12.135
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Clostridium difficile infection (CDI) is considered to be the main cause of bacterial infectious diarrhea in nosocomial settings. Since the beginning of the new century a continuous rise in the incidence of severe CDI has been observed worldwide. Even though some CDI cases are not associated with previous antibiotic exposure, this remains as the principal risk factor for the development of CDI. The rate of recurrences represents perhaps one the most challenging aspect on the management of CDI. There are several microbiological tests available, but glutamate dehydrogenase antigen test can be selected as the first screening step in a diagnostic algorithm, with positive samples then confirmed using a toxin(s) test, to distinguish toxinogenic from nontoxinogenic CDI. Although metronidazole and vancomycin are and have been the mainstay treatment options for CDI, there are some unmet medical and therapeutical needs. Usually oral metronidazole is recommended for initial treatment of nonsevere CDI and vancomycin for treatment of severe disease. Fidaxomicin may be considered in patients who cannot tolerate vancomycin, although more data are needed. For treatment of a nonsevere initial recurrence of CDI, oral metronidazole should be used, but for treatment of subsequent recurrences or more severe cases fidaxomicin may be helpful.
引用
收藏
页码:1405 / 1423
页数:19
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