儿童复发性艰难梭菌感染的诊治进展

Diagnosis and treatment of recurrent Clostridium difficile infection in children

艰难梭菌(clostridium difficile,CD)是一种革兰氏阳性厌氧芽孢杆菌,是引起抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)的主要原因。近年来,随着广谱抗生素的普遍应用,儿童中艰难梭菌感染的发病率不断上升,而复发性艰难梭菌感染(recurrent clostridium difficile infection,RCDI)需要更长时间的治疗及更高的医疗耗费。恶性肿瘤、近期手术和抗生素暴露是儿童RCDI的高危因素。产毒菌株培养和细胞毒素中和试验在过去是诊断金标准,但已出现核酸扩增试验等新的诊断方法。目前RCDI的治疗包括抗生素、粪菌移植(fecal microbiota transplantation,FMT)及单克隆抗体等。该文主要就儿童RCDI的高危因素及诊治进展进行综述。

Clostridium difficile(CD),a gram-positive,spore-forming,obligate anaerobic bacillus,is a leading cause of antibiotic-associated diarrhea(AAD)worldwide.With the widespread use of broad-spectrum antibiotics,the incidence of clostridium difficile infection in children is rising,while recurrent clostridium difficile infection(RCDI)requires prolonged treatment and higher medical costs.Malignancy,recent surgery and antibiotic exposures have been identified as the risk factors in children.While the toxigenic strains culture and the cell cytotoxicity neutralization assay are gold standard for the diagnosis,new diagnostic approaches such as nucleic acid amplification method have become available.The use of antibiotics,fecal microbiota transplantation(FMT)or monoclonal antibodies are included in the current treatments for RCDI.This review will cover published studies to discuss the risk factors,diagnosis and treatment of RCDI in children.