Acute diarrhea in the hospitalized immunocompromised patient: what is new on diagnostic and treatment?

IF 3.5 3区医学 Q1 CRITICAL CARE MEDICINE Current Opinion in Critical Care Pub Date : 2024-10-01 Epub Date: 2024-07-19 DOI:10.1097/MCC.0000000000001191

Natalia E Castillo Almeida, Carlos A Gomez

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Abstract

Purpose of review: This article aims to provide an intuitive framework for diagnosing and managing healthcare-associated diarrhea (HCAD) in the immunocompromised (IC) host.

Recent findings: Our understanding of diarrhea in hospitalized IC patients has significantly evolved. However, the challenge lies in distinguishing between these patients' numerous causes of diarrhea. The incorporation of gastrointestinal (GI) multiplex polymerase chain reaction (PCR) panels has led to a paradigm shift in our approach to diarrhea. However, using these panels judiciously is of utmost importance, as their misuse can lead to over-testing, overtreatment, and increased hospital costs. We propose a stepwise diagnostic algorithm that ensures diagnostic stewardship, optimal patient care, and resource utilization.

Summary: Diarrhea is a common complication in hospitalized IC patients and is associated with significant morbidity and rare mortality. The advent of new diagnostics, such as GI multiplex PCR panels, holds promise in facilitating the detection of recognized pathogens and may allow for improved outcomes using pathogen-targeted therapy.

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住院免疫力低下患者的急性腹泻：诊断和治疗的新进展？

本综述的目的：本文旨在为诊断和管理免疫功能低下（IC）宿主的医源性腹泻（HCAD）提供一个直观的框架：近期发现：我们对住院 IC 患者腹泻的认识有了很大发展。最近的研究结果：我们对住院 IC 患者腹泻的认识有了长足的进步，但如何区分这些患者腹泻的多种原因仍是一项挑战。胃肠道（GI）多重聚合酶链式反应（PCR）检测试剂盒的采用使我们处理腹泻的方法发生了范式转变。然而，审慎使用这些试剂盒至关重要，因为滥用这些试剂盒会导致过度检测、过度治疗和医院成本增加。摘要：腹泻是住院 IC 患者的常见并发症，与严重的发病率和罕见的死亡率有关。新型诊断方法（如消化道多重 PCR 检测板）的出现有望促进公认病原体的检测，并可通过病原体靶向治疗改善疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.