艰难梭菌感染的流行状况及诊治进展

Research progress of Clostridium difficile infection in the epidemiology,diagnosis and treatment

近年来,艰难梭菌感染(Clostridium difficile Infection,CDI)的发生频率在世界各地呈上升趋势,已成为令人担忧的健康问题。高毒力株027/NAP1/BI的出现导致该病在全球特别是欧洲和北美的流行暴发迅速增多,严重病例数、复发率和病死率均明显增高,耐药菌株也在增多。CDI的临床表现多样,可以是轻度水样腹泻,也可以是威胁患者生命的结肠炎、中毒性巨结肠和败血症。实验诊断方法包括艰难梭菌的厌氧培养、细胞毒性试验、菌体及毒素抗原检测、毒素基因扩增检测等。治疗时应首先停用相关的抗生素,应用抗艰难梭菌的抗生素、免疫调节剂及益生菌调节肠道菌群。

Inrecentyears, withtheincreaseinthefrequencyofClostridiumdifficileinfection（CDI） worldwide, CDIhasbecomeahealth concern. Because of the emergence and epidemic of the BI/NAP1/027 hypervirulent strain, the epidemic and outbreaks of CDI increase rapidly all over the world, especially in Europe and north American. As a result, there is an increase in severe cases, recurrence rates, mortality rates as well as drug resistant strains. CDI has a wide range of clinical features from mild diarrhea to life-threatening colitis, toxic megaeolon and sepsis. The methods of laboratory diagnosis include anaerobic culture, eytotoxieity test, toxin antigen detection, and toxin gene amplification test, etc. The treatment of CDI is to stop using the related antibiotics and to choose antibiotic agents against C. difficile, immune-modifying agents and probiotics instead.