中国成人炎症性肠病合并艰难梭菌感染处理专家共识
摘要
<正>艰难梭菌是临床最常见的机会致病菌,感染率、致死率及复发感染率居高不下。炎症性肠病(inflammatory bowel disease,IBD)是艰难梭菌感染(Clostridium difficile infection,CDI)的独立危险因素,近年来世界范围内IBD患者艰难梭菌感染率呈增加趋势。IBD患者感染艰难梭菌后,通常病情加重,住院时间延长。迄今为止,尚无专门针对IBD合并CDI临床处理的指南、行业标准或专家共识出台。本共识制定小组组织国内外消化领域知名专家,共同撰写中国成人炎症性
引文
[1]中华医学会消化病学分会炎症性肠病学组炎症性肠病诊断与治疗的共识意见(2018年·北京)[J].中国实用内科杂志,2018,38(9):796-813.
[2]朱新宇,付莉婷,赵慧华,等.粪菌移植治疗腹泻型肠易激综合征患者的临床及护理实践[J].中国临床医学,2018,25(4):613-616.
[3]沈许燕,方家恒,张舒琪,等.炎症性肠病合并艰难梭菌感染的研究进展[J].国际消化病杂志,2017,37(6):341-343,351.
[4]D’aoust J,Battat R,Bessissow T.Management of inflammatory bowel disease with Clostridium difficile infection[J].World JGastroenterol,2017,23(27):4986-5003.
[5]秦娟秀,马硝惟,戴颖欣,等.炎症性肠病患者中艰难梭菌感染的分子流行特征[J].中国感染与化疗杂志,2016,16(6):761-766.
[6]白璐,马英杰,冯素萍,等.艰难梭菌感染与炎症性肠病的关系研究[J].中华医院感染学杂志,2016,26(13):2910-2911,2927.
[7]韦舒静,董利军,鲁晓岚,等.艰难梭菌在肠易激综合征和炎症性肠病患者中的感染情况及与白细胞介素-8基因-251A/T多态性的关系研究[J].国际消化病杂志,2016,36(2):115-118.
[8]Zhang T,Lin QY,Fei JX,et al.Clostridium Difficile Infection Worsen Outcome of Hospitalized Patients with Inflammatory Bowel Disease[J].Sci Rep,2016,6(1):29791-29798.
[9]Bhandari S,Mohammed A,Dhakal B,et al.Increased Rate of Venous Thromboembolism in Hospitalized Inflammatory Bowel Disease Patients with Clostridium Difficile Infection[J].Inflamm Bowel Dis,2017,23(10):1847-1852.
[10]Law CC,Tariq R,Khanna S,et al.Systematic review with metaanalysis:the impact of Clostridium difficile infection on the shortand long-term risks of colectomy in inflammatory bowel disease[J].Aliment Pharmacol Ther,2017,45(8):1011-1020.
[11]Rezapour M,Galoosian A,Liu B,et al.Clostridium difficile coinfection in inflammatory bowel disease is associated with significantly increased in-hospital mortality[J].Eur J Gastroenterol Hepatol,2018,30(9):1041-1046.
[12]Wang P,Zhou Y,Wang Z,et al.Identification of Clostridium difficile ribotype 027 for the first time in Mainland China[J].Infect Control Hosp Epidemiol,2014,35(1):95-98.
[13]黄耀旂.炎症性肠病患者艰难梭菌感染率及相关分析[J].实用临床医药杂志,2017,21(21):214-215.
[14]李玥,钱家鸣.炎症性肠病合并艰难梭菌感染的研究进展[J].临床荟萃,2018,33(5):394-397.
[15]罗雨欣,韩菲,张瑞苗,等.艰难梭菌感染的流行病学及危险因素[J].临床荟萃,2018,33(5):369-372.
[16]Micic D,Yarur A,Gonsalves A,et al.Risk Factors for Clostridium difficile Isolation in Inflammatory Bowel Disease:AProspective Study[J].Dig Dis Sci,2018,63(4):1016-1024.
[17]Balram B,Battat R,Al-khoury A,et al.Risk Factors Associated with Clostridium difficile Infection in Inflammatory Bowel Disease:A Systematic Review and Meta-Analysis[J].J Crohns Colitis,2019,13(1):27-38.
[18]Maharshak N,Barzilay I,Zinger H,et al.Clostridium difficile infection in hospitalized patients with inflammatory bowel disease:Prevalence,risk factors,and prognosis[J].Medicine(Baltimore),2018,97(5):9772-9778.
[19]Dai C,Jiang M,Sun MJ.Clostridium difficile Infection Among Individuals With Inflammatory Bowel Disease[J].Gastroenterology,2018,154(1):256.
[20]Stallmach A,Anttila VJ,Hell M,et al.Inflammatory bowel disease and Clostridium difficile infection:contrasting views of international clinical professionals[J].Z Gastroenterol,2018,1(1):1-7.
[21]Knyazev OV,Kagramanova AV,Chernova ME,et al.Clostridium difficile in inflammatory bowel disease[J].Ter Arkh,2018,90(11):32-36.
[22]Tang YM,Stone CD.Clostridium difficile infection in inflammatory bowel disease:challenges in diagnosis and treatment[J].Clin JGastroenterol,2017,10(2):112-123.
[23]郭旭光,王婷,汤昕,等.艰难梭菌实验室诊断研究进展[J].国际检验医学杂志,2018,39(16):2043-2045.
[24]王丽志,陈丽丹,肖斌,等.3种艰难梭菌感染检测方法的比较[J].南方医科大学学报,2017,37(12):1648-1653.
[25]Tilton CS,Johnson SW.Development of a risk prediction model for hospital-onset Clostridium difficile infection in patients receiving systemic antibiotics[J].Am J Infect Control,2019;47(3):280-284.
[26]秦娟秀,张灏旻,刘倩,等.艰难梭菌谷氨酸脱氢酶抗原及毒素检测试剂盒的性能评估[J].检验医学,2017,32(12):1152-1155.
[27]Madden GR,Poulter MD,Sifri CD.Diagnostic stewardship and the 2017 update of the IDSA-SHEA Clinical Practice Guidelines for Clostridium difficile Infection[J].Diagnosis(Berl),2018,5(3):119-125.
[28]Swale A,Miyajima F,Roberts P,et al.Calprotectin and lactoferrin faecal levels in patients with Clostridium difficile infection(CDI):a prospective cohort study[J].PLo S One,2014,9(8):106118-106125.
[29]Anikst VE,Gaur RL,Schroeder LF,Banaei N.Organism burden,toxin concentration,and lactoferrin concentration do not distinguish between clinically significant and nonsignificant diarrhea in patients with Clostridium difficile[J].Diagn Microbiol Infect Dis,2016,84(4):343-346.
[30]Hashash JG,Binion DG.Managing Clostridium difficile in inflammatory bowel disease(IBD)[J].Curr Gastroenterol Rep,2014,16(7):393-398.
[31]Vickers RJ,Tillotson GS,Nathan R,et al.Efficacy and safety of ridinilazole compared with vancomycin for the treatment of Clostridium difficile infection:a phase 2,randomised,doubleblind,active-controlled,non-inferiority study[J].Lancet Infect Dis,2017,17(7):735-744.
[32]Stallmach A,Reuken PA,Teich N.Advances in the diagnosis and treatment of Clostridioides Clostridium difficile infections in inflammatory bowel disease[J].Z Gastroenterol,2018,56(11):1369-1377.
[33]赵杏珍,赵建宏,魏宏莲,等.万古霉素和非达霉素对艰难梭菌体外抗菌活性的稳定性[J].中国感染控制杂志,2018,17(6):461-466.
[34]Razik R,Rumman A,Bahreini Z,et al.Recurrence of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease:The RECIDIVISM Study[J].Am J Gastroenterol,2016,111(8):1141-1146.
[35]Guery B,Menichetti F,Anttila VJ,et al.Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older(EXTEND):a randomised,controlled,open-label,phase 3b/4 trial[J].Lancet Infect Dis,2018,18(3):296-307.
[36]Cornely OA,Watt M,Mccrea C,et al.Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients aged≥60 years(EXTEND):analysis of cost-effectiveness[J].J Antimicrob Chemother,2018,73(9):2529-2539.
[37]Khanna S,Shin A,Kelly CP.Management of Clostridium difficile Infection in Inflammatory Bowel Disease:Expert Review from the Clinical Practice Updates Committee of the AGA Institute[J].Clin Gastroenterol Hepatol,2017,15(2):166-174.
[38]Mushtaq A.New clinical recommendations for Clostridium difficile[J].Lancet Infect Dis,2018,18(4):384.
[39]Fu N,Wong T.Clostridium difficile Infection in Patients with Inflammatory Bowel Disease[J].Curr Infect Dis Rep,2016,18(6):19-24.
[40]徐镇杰,赵渊,曹倩.粪菌移植在炎症性肠病中的疗效研究[J].国际消化病杂志,2017,37(1):47-66.
[41]向丽园,张发明.粪菌移植在艰难梭菌感染治疗中的应用[J].临床荟萃,2018,33(5):385-389.
[42]Patel K,Patel A,Hawes D,et al.Faecal microbiota transplantation:looking beyond clostridium difficile infection at inflammatory bowel disease[J].Gastroenterol Hepatol Bed Bench,2018,11(1):1-8.
[43]Lukin DJ,Lawlor G,Hudesman DP,et al.Escalation of immunosuppressive therapy for inflammatory bowel disease is not associated with adverse outcomes after infection with Clostridium difficile[J].Inflamm Bowel Dis,2019,25(4):775-781.
[44]Lim HW,Schuster IP,Rajapakse R,et al.The impact of corticosteroid use on inpatients with inflammatory bowel disease and positive polymerase chain reaction for Clostridium difficile[J].Intest Res,2019,2(1):1-9.
[45]Chieng M.Clostridium difficile infections in patients with inflammatory bowel disease[J].N Z Med J,2017,130(1452):68-70.
[46]贾红兵,杨辉,杜鹏程,等.艰难梭菌临床分离株的毒素检测和MLST分型[J].中华微生物学和免疫学杂志,2017,37(4):297-302.
[47]Barker AK,Zellmer C,Tischendorf J,et al.On the hands of patients with Clostridium difficile:A study of spore prevalence and the effect of hand hygiene on C difficile removal[J].Am J Infect Control,2017,45(10):1154-1156.
[48]郭凤玲,温世宝,胡旻,等.5种手卫生方法对艰难梭菌清除效果比较[J].中国消毒学杂志,2015,32(7):737-738.
[49]Ray AJ,Deshpande A,Fertelli D,et al.A multicenter randomized Trial to determine the effectofan environmental disinfection Intervention on the incidence of healthcare-associated Clostridium difficile infection[J].Infect Control Hosp Epidemiol,2017,38(7):777-783.
[50]Daniels LM,Kufel WD.Clinical review of Clostridium difficile infection:an update on treatment and prevention[J].Expert Opin Pharmacother,2018,19(16):1759-1769.
[51]Sokol H,Lalande V,Landman C,et al.Clostridium difficile infection in acute flares of inflammatory bowel disease:Aprospective study[J].Dig Liver Dis,2017,49(6):643-646.
[52]Matsuoka O,Patel DM,Sasaki S,et al.Safety and immunogenicity of Clostridium difficile toxoid vaccine in Japanese adults[J].Hum Vaccin Immunother,2018,14(2):322-328.
[53]Senoh M,Iwaki M,Yamamoto A,et al.Development of vaccine for Clostridium difficile infection using membrane fraction of nontoxigenic Clostridium difficile[J].Microb Pathog,2018,123(1):42-46.
[2]朱新宇,付莉婷,赵慧华,等.粪菌移植治疗腹泻型肠易激综合征患者的临床及护理实践[J].中国临床医学,2018,25(4):613-616.
[3]沈许燕,方家恒,张舒琪,等.炎症性肠病合并艰难梭菌感染的研究进展[J].国际消化病杂志,2017,37(6):341-343,351.
[4]D’aoust J,Battat R,Bessissow T.Management of inflammatory bowel disease with Clostridium difficile infection[J].World JGastroenterol,2017,23(27):4986-5003.
[5]秦娟秀,马硝惟,戴颖欣,等.炎症性肠病患者中艰难梭菌感染的分子流行特征[J].中国感染与化疗杂志,2016,16(6):761-766.
[6]白璐,马英杰,冯素萍,等.艰难梭菌感染与炎症性肠病的关系研究[J].中华医院感染学杂志,2016,26(13):2910-2911,2927.
[7]韦舒静,董利军,鲁晓岚,等.艰难梭菌在肠易激综合征和炎症性肠病患者中的感染情况及与白细胞介素-8基因-251A/T多态性的关系研究[J].国际消化病杂志,2016,36(2):115-118.
[8]Zhang T,Lin QY,Fei JX,et al.Clostridium Difficile Infection Worsen Outcome of Hospitalized Patients with Inflammatory Bowel Disease[J].Sci Rep,2016,6(1):29791-29798.
[9]Bhandari S,Mohammed A,Dhakal B,et al.Increased Rate of Venous Thromboembolism in Hospitalized Inflammatory Bowel Disease Patients with Clostridium Difficile Infection[J].Inflamm Bowel Dis,2017,23(10):1847-1852.
[10]Law CC,Tariq R,Khanna S,et al.Systematic review with metaanalysis:the impact of Clostridium difficile infection on the shortand long-term risks of colectomy in inflammatory bowel disease[J].Aliment Pharmacol Ther,2017,45(8):1011-1020.
[11]Rezapour M,Galoosian A,Liu B,et al.Clostridium difficile coinfection in inflammatory bowel disease is associated with significantly increased in-hospital mortality[J].Eur J Gastroenterol Hepatol,2018,30(9):1041-1046.
[12]Wang P,Zhou Y,Wang Z,et al.Identification of Clostridium difficile ribotype 027 for the first time in Mainland China[J].Infect Control Hosp Epidemiol,2014,35(1):95-98.
[13]黄耀旂.炎症性肠病患者艰难梭菌感染率及相关分析[J].实用临床医药杂志,2017,21(21):214-215.
[14]李玥,钱家鸣.炎症性肠病合并艰难梭菌感染的研究进展[J].临床荟萃,2018,33(5):394-397.
[15]罗雨欣,韩菲,张瑞苗,等.艰难梭菌感染的流行病学及危险因素[J].临床荟萃,2018,33(5):369-372.
[16]Micic D,Yarur A,Gonsalves A,et al.Risk Factors for Clostridium difficile Isolation in Inflammatory Bowel Disease:AProspective Study[J].Dig Dis Sci,2018,63(4):1016-1024.
[17]Balram B,Battat R,Al-khoury A,et al.Risk Factors Associated with Clostridium difficile Infection in Inflammatory Bowel Disease:A Systematic Review and Meta-Analysis[J].J Crohns Colitis,2019,13(1):27-38.
[18]Maharshak N,Barzilay I,Zinger H,et al.Clostridium difficile infection in hospitalized patients with inflammatory bowel disease:Prevalence,risk factors,and prognosis[J].Medicine(Baltimore),2018,97(5):9772-9778.
[19]Dai C,Jiang M,Sun MJ.Clostridium difficile Infection Among Individuals With Inflammatory Bowel Disease[J].Gastroenterology,2018,154(1):256.
[20]Stallmach A,Anttila VJ,Hell M,et al.Inflammatory bowel disease and Clostridium difficile infection:contrasting views of international clinical professionals[J].Z Gastroenterol,2018,1(1):1-7.
[21]Knyazev OV,Kagramanova AV,Chernova ME,et al.Clostridium difficile in inflammatory bowel disease[J].Ter Arkh,2018,90(11):32-36.
[22]Tang YM,Stone CD.Clostridium difficile infection in inflammatory bowel disease:challenges in diagnosis and treatment[J].Clin JGastroenterol,2017,10(2):112-123.
[23]郭旭光,王婷,汤昕,等.艰难梭菌实验室诊断研究进展[J].国际检验医学杂志,2018,39(16):2043-2045.
[24]王丽志,陈丽丹,肖斌,等.3种艰难梭菌感染检测方法的比较[J].南方医科大学学报,2017,37(12):1648-1653.
[25]Tilton CS,Johnson SW.Development of a risk prediction model for hospital-onset Clostridium difficile infection in patients receiving systemic antibiotics[J].Am J Infect Control,2019;47(3):280-284.
[26]秦娟秀,张灏旻,刘倩,等.艰难梭菌谷氨酸脱氢酶抗原及毒素检测试剂盒的性能评估[J].检验医学,2017,32(12):1152-1155.
[27]Madden GR,Poulter MD,Sifri CD.Diagnostic stewardship and the 2017 update of the IDSA-SHEA Clinical Practice Guidelines for Clostridium difficile Infection[J].Diagnosis(Berl),2018,5(3):119-125.
[28]Swale A,Miyajima F,Roberts P,et al.Calprotectin and lactoferrin faecal levels in patients with Clostridium difficile infection(CDI):a prospective cohort study[J].PLo S One,2014,9(8):106118-106125.
[29]Anikst VE,Gaur RL,Schroeder LF,Banaei N.Organism burden,toxin concentration,and lactoferrin concentration do not distinguish between clinically significant and nonsignificant diarrhea in patients with Clostridium difficile[J].Diagn Microbiol Infect Dis,2016,84(4):343-346.
[30]Hashash JG,Binion DG.Managing Clostridium difficile in inflammatory bowel disease(IBD)[J].Curr Gastroenterol Rep,2014,16(7):393-398.
[31]Vickers RJ,Tillotson GS,Nathan R,et al.Efficacy and safety of ridinilazole compared with vancomycin for the treatment of Clostridium difficile infection:a phase 2,randomised,doubleblind,active-controlled,non-inferiority study[J].Lancet Infect Dis,2017,17(7):735-744.
[32]Stallmach A,Reuken PA,Teich N.Advances in the diagnosis and treatment of Clostridioides Clostridium difficile infections in inflammatory bowel disease[J].Z Gastroenterol,2018,56(11):1369-1377.
[33]赵杏珍,赵建宏,魏宏莲,等.万古霉素和非达霉素对艰难梭菌体外抗菌活性的稳定性[J].中国感染控制杂志,2018,17(6):461-466.
[34]Razik R,Rumman A,Bahreini Z,et al.Recurrence of Clostridium difficile Infection in Patients with Inflammatory Bowel Disease:The RECIDIVISM Study[J].Am J Gastroenterol,2016,111(8):1141-1146.
[35]Guery B,Menichetti F,Anttila VJ,et al.Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older(EXTEND):a randomised,controlled,open-label,phase 3b/4 trial[J].Lancet Infect Dis,2018,18(3):296-307.
[36]Cornely OA,Watt M,Mccrea C,et al.Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients aged≥60 years(EXTEND):analysis of cost-effectiveness[J].J Antimicrob Chemother,2018,73(9):2529-2539.
[37]Khanna S,Shin A,Kelly CP.Management of Clostridium difficile Infection in Inflammatory Bowel Disease:Expert Review from the Clinical Practice Updates Committee of the AGA Institute[J].Clin Gastroenterol Hepatol,2017,15(2):166-174.
[38]Mushtaq A.New clinical recommendations for Clostridium difficile[J].Lancet Infect Dis,2018,18(4):384.
[39]Fu N,Wong T.Clostridium difficile Infection in Patients with Inflammatory Bowel Disease[J].Curr Infect Dis Rep,2016,18(6):19-24.
[40]徐镇杰,赵渊,曹倩.粪菌移植在炎症性肠病中的疗效研究[J].国际消化病杂志,2017,37(1):47-66.
[41]向丽园,张发明.粪菌移植在艰难梭菌感染治疗中的应用[J].临床荟萃,2018,33(5):385-389.
[42]Patel K,Patel A,Hawes D,et al.Faecal microbiota transplantation:looking beyond clostridium difficile infection at inflammatory bowel disease[J].Gastroenterol Hepatol Bed Bench,2018,11(1):1-8.
[43]Lukin DJ,Lawlor G,Hudesman DP,et al.Escalation of immunosuppressive therapy for inflammatory bowel disease is not associated with adverse outcomes after infection with Clostridium difficile[J].Inflamm Bowel Dis,2019,25(4):775-781.
[44]Lim HW,Schuster IP,Rajapakse R,et al.The impact of corticosteroid use on inpatients with inflammatory bowel disease and positive polymerase chain reaction for Clostridium difficile[J].Intest Res,2019,2(1):1-9.
[45]Chieng M.Clostridium difficile infections in patients with inflammatory bowel disease[J].N Z Med J,2017,130(1452):68-70.
[46]贾红兵,杨辉,杜鹏程,等.艰难梭菌临床分离株的毒素检测和MLST分型[J].中华微生物学和免疫学杂志,2017,37(4):297-302.
[47]Barker AK,Zellmer C,Tischendorf J,et al.On the hands of patients with Clostridium difficile:A study of spore prevalence and the effect of hand hygiene on C difficile removal[J].Am J Infect Control,2017,45(10):1154-1156.
[48]郭凤玲,温世宝,胡旻,等.5种手卫生方法对艰难梭菌清除效果比较[J].中国消毒学杂志,2015,32(7):737-738.
[49]Ray AJ,Deshpande A,Fertelli D,et al.A multicenter randomized Trial to determine the effectofan environmental disinfection Intervention on the incidence of healthcare-associated Clostridium difficile infection[J].Infect Control Hosp Epidemiol,2017,38(7):777-783.
[50]Daniels LM,Kufel WD.Clinical review of Clostridium difficile infection:an update on treatment and prevention[J].Expert Opin Pharmacother,2018,19(16):1759-1769.
[51]Sokol H,Lalande V,Landman C,et al.Clostridium difficile infection in acute flares of inflammatory bowel disease:Aprospective study[J].Dig Liver Dis,2017,49(6):643-646.
[52]Matsuoka O,Patel DM,Sasaki S,et al.Safety and immunogenicity of Clostridium difficile toxoid vaccine in Japanese adults[J].Hum Vaccin Immunother,2018,14(2):322-328.
[53]Senoh M,Iwaki M,Yamamoto A,et al.Development of vaccine for Clostridium difficile infection using membrane fraction of nontoxigenic Clostridium difficile[J].Microb Pathog,2018,123(1):42-46.