艰难拟梭菌感染的实验室诊断及治疗进展

Advance of laboratory diagnosis and therapy of Clostridioides difficile infection

艰难拟梭菌(Clostridioides difficile,CD)是医院内感染性腹泻和抗生素相关性腹泻的主要病原菌,抗生素、高龄、接受侵入性操作以及免疫抑制剂和化疗药物的使用均可导致产毒的CD过度繁殖,引起艰难拟梭菌感染(Clostridioides difficile infection,CDI)。近年来,CDI的发病率和严重程度在全球范围内不断上升,且在多地出现高产毒株的暴发流行,给临床诊断和治疗带来严峻的考验,受到医疗界的广泛关注。CD的主要致病因子是毒素A和毒素B,因此毒素检测在CDI的实验室诊断中起着关键性的作用。鉴于CD毒素培养及分离鉴定较为困难,目前尚无一种检测方法能完美涵盖CDI的实验室诊断。因此本文将就CD的实验室检测方法、诊断及治疗的研究进展进行综述。

Clostridioides difficile is a leading pathogen of infectious diarrhea and antibiotic-associated diarrhea in hospitals.Antibiotics,advanced age,invasive procedures,and the use of immunosuppressive and chemotherapeutic drugs can all leads to excessive reproduction of toxin-producing CDs and cause C.difficile infection(CDI).In recent years,the incidence and severity of CDI have been increasing worldwide,and the outbreaks of high-virulent C.difficile strains have appeared in many places,which brought severe challenges to clinical diagnosis and treatment,and has received widespread attention from the medical community.The main pathogenic factors of C.difficile are toxin A and toxin B,therefore the detection of toxin is the most crucial part in the laboratory diagnosis of CDI.In view of the difficulty in culture and isolation and identification of C.difficile toxins,there is currently no single detection method that can perfectly diagnose CDI.Therefore,this article will review the research progress of laboratory detection methods,diagnosis and treatment of CDI.