困難梭狀桿菌的治療趨勢

Current Management of Clostridium difficile infection

過去十年內，困難梭狀桿菌的預防與控制在健康照護上已經是全球公共衛生的一個挑戰。在世界各地的盛行率顯著升高，且造成許多死亡事件。因大量使用廣效性抗生素使這些病患得到這種感染的風險增加，且改變了困難梭狀桿菌的流行病學。新型態高致病性困難梭狀桿菌的出現，以及越來越多的治療失敗及再發病例，都對我們的臨床執業造成莫大威脅。自從1970年代，口服metronidazole或vancomycin就已經是標準治療，雖然這些抗生素可以有效抑制困難梭狀桿菌的複製並減輕症狀，但使用這些藥物並不能重建正常腸內菌叢。因此，高達15-30%病患最終在停藥後再次感染。除了抗生素外，科學家已經研發出可以有效對抗困難梭狀桿菌毒素A的單株抗體，並在初期研究中顯示可以有效降低感染再發風險。本文回顧最近困難梭狀桿菌的流行病學、藥物治療趨勢與建議。

In the last decade, the prevention and control of Clostridium difficile infection in healthcare settings has become a global public health challenge. The widespread use of broad-spectrum antibiotics places patients at the risk of C. difficile - associated diarrhea or colitis and has changed the epidemiology of C. difficile infection. This change has been characterized by the emergence of a hypervirulent strain of C. difficile and an increasing risk of treatment failure and recurrent infection. Standard therapy for C. difficile infection, which involves administration of oral metronidazole or vancomycin, has not changed since the 1970s. Although antibiotic treatments are effective for inhibiting C. difficile infection and for treating symptoms, these drugs do not permit the reestablishment of normal bowel flora. As a result, 15-30% of patients develop recurrent C. difficile infection after the treatment ceases. Besides antibiotics, investigators have developed human monoclonal antibodies that target the C. difficile toxins A (CDA1) and B (CDB1). A preliminary study showed that the addition of these antibodies to antibiotic regimens could significantly reduce the recurrence of C. difficile infection. We reviewed the recent advances in the epidemiology, treatment options, and recommendations for control of C. difficile infection.