期刊
CURRENT OPINION IN GASTROENTEROLOGY
卷 29, 期 1, 页码 42-48出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOG.0b013e32835a68d4
关键词
acid suppression therapy; Clostridium difficile; fecal microbiota transplantation; fidaxomicin; molecular diagnostics
资金
- Hines VA Hospital
- US Department of Veterans Affairs Research Service [I01 BX000121]
- Merck
- Actelion
- Cubist
Purpose of review Clostridium difficile remains an important cause of infectious colitis, particularly in healthcare facilities. This review summarizes recent advances in the epidemiology, diagnosis, and treatment of this endemic pathogen. Recent findings C. difficile infection (CDI) hospitalizations and mortality rates have increased over the last decade. The BI/NAP1/027 strain has been responsible for epidemics with increased severity and mortality and is now endemic in many settings, particularly North America. Concurrent antibiotics have now been shown to decrease the cure rates for anti-C. difficile therapy and increase the risk of recurrence. Although studies implicate proton pump inhibitors as a risk for CDI, the magnitude of and the biological basis for that risk remain unclear. Molecular diagnostic techniques are rapid and sensitive but highlight the importance of using appropriate clinical testing criteria. Fidaxomicin is a promising new therapy associated with decreased recurrence; infections due to BI strains, however, are associated with inferior outcomes regardless of the treatment agent. Fecal transplantation continues to have impressive success rates for patients with recurrent CDI, and a new colon-sparing surgical procedure presents an intriguing suggested alternative to total colectomy in severe, complicated cases. Summary Elucidating CDI risk factors, identifying rapid, accurate diagnostic tools, and validating new treatment approaches remains an urgent priority.
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