[Clostridioides difficile infections: Update and therapeutic guidelines].

IF 0.4 4区 医学 Q4 PSYCHIATRY Geriatrie et Psychologie Neuropsychiatrie De Vieillissement Pub Date : 2024-10-08 DOI:10.1684/pnv.2024.1181
Gilles Berrut, Claire Roubaud Baudron, Marc Paccalin, Benoit de Wazières, Gaëtan Gavazzi
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Abstract

Clostridioides difficile infection (CDI) represents a significant challenge due to its increasing incidence, severity, and treatment difficulty. Effective management requires a multifactorial approach that includes preventive strategies, prudent antibiotic use, and adapted therapeutic options. Ongoing research and innovation offer promising prospects for improving ICD management, making vigilance and informed practices essential among healthcare professionals. Two main complications of ICD are pseudomembranous colitis (PMC) and toxic megacolon. PMC involves severe colonic inflammation due to C. difficile toxins, leading to pseudomembrane formation. Diagnosis relies on clinical criteria, microbiological tests, and endoscopy. Toxic Megacolon is characterized by severe colonic dilation and systemic toxicity, requiring immediate medical intervention. ICD diagnosis combines clinical signs and microbiological tests. These tests include toxin tests, GDH antigen detection, PCR for toxin genes, and stool culture. Imaging techniques assess colonic inflammation and complications. Combined diagnostic criteria from the American Gastroenterological Association (AGA) and European guidelines emphasize integrating clinical and laboratory findings for accurate diagnosis. ICD treatment involves stopping the implicated antibiotics and starting specific antimicrobial therapy. Common treatments include mainly fidaxomicin and oral vancomycin. Fecal microbiota transplantation (TMF) is recommended for recurrent cases unresponsive to standard treatments. Bezlotoxumab, an antibody targeting C. difficile toxin B, is used to prevent recurrence in high-risk adults. ICD poses a major challenge due to its increasing incidence, severity, and difficulty in treatment. A multifactorial approach involving rigorous preventive strategies, prudent antibiotic management, and adapted therapeutic options is essential for controlling the infection. Ongoing research and innovations in treatment offer promising prospects for improving patient management. Healthcare professionals must remain vigilant and informed to ensure effective practices in combating this infection and utilizing available resources optimally.

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[艰难梭菌感染:最新进展和治疗指南]。
艰难梭菌感染(CDI)因其发病率、严重程度和治疗难度不断增加而成为一项重大挑战。有效的管理需要采取多因素方法,包括预防策略、谨慎使用抗生素和调整治疗方案。不断进行的研究和创新为改善 ICD 的管理提供了广阔的前景,因此医护人员必须保持警惕并采取明智的做法。ICD 的两个主要并发症是假膜性结肠炎(PMC)和中毒性巨结肠。假膜性结肠炎是由艰难梭菌毒素引起的严重结肠炎症,导致假膜形成。诊断依赖于临床标准、微生物检测和内窥镜检查。中毒性巨结肠的特点是结肠严重扩张和全身中毒,需要立即进行医疗干预。ICD 诊断结合了临床症状和微生物检测。这些检测包括毒素检测、GDH 抗原检测、毒素基因 PCR 检测和粪便培养。成像技术可评估结肠炎症和并发症。美国胃肠病学协会(AGA)和欧洲指南的综合诊断标准强调综合临床和实验室检查结果进行准确诊断。ICD 的治疗包括停用相关抗生素并开始特定的抗菌治疗。常见的治疗方法主要包括非达霉素和口服万古霉素。对于标准治疗无效的复发病例,建议进行粪便微生物群移植(TMF)。针对艰难梭菌毒素 B 的抗体 Bezlotoxumab 可用于预防高风险成人的复发。由于 ICD 的发病率、严重程度和治疗难度不断增加,它已成为一项重大挑战。要控制感染,必须采取多因素方法,包括严格的预防策略、审慎的抗生素管理和适当的治疗方案。正在进行的研究和治疗创新为改善患者管理提供了广阔的前景。医疗保健专业人员必须保持警惕并了解相关信息,以确保有效地防治这种感染并充分利用现有资源。
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来源期刊
CiteScore
0.70
自引率
16.70%
发文量
0
审稿时长
6-12 weeks
期刊介绍: D''une qualité scientifique reconnue cette revue est, la première revue francophone gériatrique et psychologique indexée dans les principales bases de données internationales. Elle couvre tous les aspects médicaux, psychologiques, sanitaires et sociaux liés au suivi et à la prise en charge de la personne âgée. Que vous soyez psychologues, neurologues, psychiatres, gériatres, gérontologues,... vous trouverez à travers cette approche originale et unique, un veritable outil de formation, de réflexion et d''échanges indispensable à votre pratique professionnelle.
期刊最新文献
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