艰难梭菌复发感染的早期识别和合理治疗
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R51

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国家自然科学基金面上项目(82072315)


Early identification and rational treatment of recurrent Clostridioides difficile infection
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    摘要:

    目的 分析西南地区艰难梭菌复发感染(rCDI)患者的临床数据,以帮助临床医生及早识别高危人群并采取合理的治疗策略。方法 收集西南地区某三级甲等医院2019年7月—2024年6月rCDI病例的临床资料,分析其宿主相关危险因素、外源性危险因素、治疗方案及终点结局等。结果 近5年西南地区某三级甲等医院共检出rCDI病例26例,占同期总检出阳性病例数(643例)的4.04%。复发患者中19.23%为再次复发。rCDI患者的中位年龄为66.5岁,其中男性占比73.08%。主要共病包括糖尿病(34.62%)、 恶性肿瘤(30.77%)、慢性肾脏疾病(23.08%)。在rCDI患者初次发作前8周内,使用药物居前三位的依次是β-内酰胺类及酶抑制剂复合制剂(69.23%)、 质子泵抑制剂(65.38%)、碳青霉烯类(46.15%)。在复发患者的初次发作治疗中,3.85%(1/26)的病例选用甲硝唑治疗,19.23%(5/26)的病例万古霉素/去甲万古霉素用法用量不符合标准疗法,46.15%(12/26)的病例疗程不足10 d。在首次复发的治疗中,有34.78%(8/26)的病例疗程不足10 d。结论 对于高龄以及患有糖尿病、恶性肿瘤、慢性肾脏疾病的患者,若其在发作前8周内曾使用过β-内酰胺类及酶抑制剂复合制剂、质子泵抑制剂、碳青霉烯类等药物,在条件允许的情况下,推荐采用万古霉素或去甲万古霉素的标准剂量和标准疗程进行治疗,以降低复发风险。

    Abstract:

    To analyze the clinical data of patients with recurrent Clostridioides difficile infection (rCDI) in the southwestern region, and help clinicians identify high-risk populations early and adopt appropriate treatment strategies. Methods Clinical data of rCDI cases from a tertiary first-class hospital in southwest China from July 2019 to June 2024 were collected, and their host-related risk factors, exogenous risk factors, treatment schemes, and endpoint outcomes were analyzed. Results In the past five years, a total of 26 cases of rCDI were detected from a ter-tiary first-class hospital in southwest China, accounting for 4.04% of the total positive cases (n=643) detected during the same period. 19.23% of the recurrent patients experienced a second recurrence. The median age of rCDI patients was 66.5 years old, with males accounting for 73.08%.The major comorbidity included diabetes mellitus (34.62%), malignant tumors (30.77%), and chronic renal diseases (23.08%). In the 8 weeks before the first onset of rCDI in patients, the top three drugs used were β-lactam and enzyme inhibitor compound (69.23%), proton pump inhibitors (65.38%), and carbapenems (46.15%). In the initial treatment of recurrent patients, 3.85% (1/26) of the cases were treated with metronidazole, 19.23% (5/26) of the cases received non-standard vancomycin/norvancomycin treatment in usage or dosage, 46.15% (12/26) of the cases received treatment with course less than 10 days. In the treatment of the first recurrence, 34.78% (8/26) of the cases received treatment with course less than 10 days. Conclusion For elderly patients and patients with diabetes mellitus, malignant tumors, and chronic renal diseases, who have used β-lactam and enzyme inhibitor compound, proton pump inhibitors, carbapenems within 8 weeks before disease onset, standard dose and treatment course of vancomycin or norvancomycin are recommended under permitted conditions, so as to reduce the risk of recurrence.

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李文君,陆鑫,权敏,等.艰难梭菌复发感染的早期识别和合理治疗[J]. 中国感染控制杂志,2025,24(7):883-889. DOI:10.12138/j. issn.1671-9638.20252062.
LI Wenjun, LU Xin, QUAN Min, et al. Early identification and rational treatment of recurrent Clostridioides difficile infection[J]. Chin J Infect Control, 2025,24(7):883-889. DOI:10.12138/j. issn.1671-9638.20252062.

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  • 收稿日期:2025-01-21
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  • 在线发布日期: 2025-07-28
  • 出版日期: 2025-07-28