Clostridium difficile infection: epidemiology, risk factors and management

被引:248
作者
Ananthakrishnan, Ashwin N. [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA 02114 USA
关键词
INFLAMMATORY-BOWEL-DISEASE; ANTIBIOTIC-ASSOCIATED DIARRHEA; PCR RIBOTYPE 027; INTRAVENOUS IMMUNOGLOBULIN; HYPERVIRULENT STRAIN; TREATMENT STRATEGIES; TOXIN-A; COLITIS; VANCOMYCIN; METRONIDAZOLE;
D O I
10.1038/nrgastro.2010.190
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The epidemiology of Clostridium difficile infection (CDI) has changed over the past decade. There has been a dramatic worldwide increase in its incidence, and new CDI populations are emerging, such as those with community-acquired infection and no previous exposure to antibiotics, children, pregnant women and patients with IBD. Diagnosis of CDI requires identification of C. difficile toxin A or B in diarrheal stool. The accuracy of current diagnostic tests remains inadequate and the optimal diagnostic testing algorithm has not been defined. The first-line agents for CDI treatment are metronidazole and vancomycin, with the latter being the preferred agent in patients with severe disease as it has significantly superior efficacy. The incidence of metronidazole treatment failures has increased, emphasizing the need to find alternative treatment options. Disease recurrence continues to occur in 20-40% of patients and its treatment remains challenging. In patients with CDI who develop fulminant colitis, early surgical consultation is essential. Intravenous immunoglobulin and tigecycline have been used in patients with severe refractory disease but delaying surgery may be associated with worse outcomes. Infection control measures are key to prevent horizontal transmission of infection. Ongoing research into effective treatment protocols and prevention is essential.
引用
收藏
页码:17 / 26
页数:10
相关论文
共 90 条
[51]   Diagnostic trends in Clostridium difficile detection in Finnish microbiology laboratories [J].
Kononen, Eija ;
Rasinpera, Marja ;
Virolainen, Anni ;
Mentula, Silja ;
Lyytikainen, Outi .
ANAEROBE, 2009, 15 (06) :261-265
[52]   Emergence of Clostridium difficile-associated disease in North America and Europe [J].
Kuijper, E. J. ;
Coignard, B. ;
Tull, P. .
CLINICAL MICROBIOLOGY AND INFECTION, 2006, 12 :2-18
[53]   Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. [J].
Kyne, L ;
Warny, M ;
Qamar, A ;
Kelly, CP .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (06) :390-397
[54]   Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea [J].
Kyne, L ;
Warny, M ;
Qamar, A ;
Kelly, CP .
LANCET, 2001, 357 (9251) :189-193
[55]   Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile [J].
Kyne, L ;
Hamel, MB ;
Polavaram, R ;
Kelly, CNP .
CLINICAL INFECTIOUS DISEASES, 2002, 34 (03) :346-353
[56]   Treatment of Clostridium difficile-Associated Disease [J].
Leffler, Daniel A. ;
Lamont, J. Thomas .
GASTROENTEROLOGY, 2009, 136 (06) :1899-1912
[57]   A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality [J].
Loo, VG ;
Poirier, L ;
Miller, MA ;
Oughton, M ;
Libman, MD ;
Michaud, S ;
Bourgault, AM ;
Nguyen, T ;
Frenette, C ;
Kelly, M ;
Vibien, A ;
Brassard, P ;
Fenn, S ;
Dewar, K ;
Hudson, TJ ;
Horn, R ;
René, P ;
Monczak, Y ;
Dascal, A .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (23) :2442-2449
[58]  
LOUIE T, 2007, INT C ANT AG CHEM WA
[59]   Treatment with Monoclonal Antibodies against Clostridium difficile Toxins [J].
Lowy, Israel ;
Molrine, Deborah C. ;
Leav, Brett A. ;
Blair, Barbra M. ;
Baxter, Roger ;
Gerding, Dale N. ;
Nichol, Geoffrey ;
Thomas, William D., Jr. ;
Leney, Mark ;
Sloan, Susan ;
Hay, Catherine A. ;
Ambrosino, Donna M. .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (03) :197-205
[60]   Clostridium difficile enteritis:: An early postoperative complication in inflammatory bowel disease patients after colectomy [J].
Lundeen, Sarah J. ;
Otterson, Mary F. ;
Binion, David G. ;
Carman, Emily T. ;
Peppard, William J. .
JOURNAL OF GASTROINTESTINAL SURGERY, 2007, 11 (02) :138-142