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中国成人艰难梭菌感染诊断和治疗专家共识

中国医师协会检验医师分会感染性疾病检验医学专家委员会 徐英春 张曼

中国医师协会检验医师分会感染性疾病检验医学专家委员会, 徐英春, 张曼. 中国成人艰难梭菌感染诊断和治疗专家共识[J]. 协和医学杂志, 2017, 8(2-3): 131-138. doi: 10.3969/j.issn.1674-9081.2017.03.010
引用本文: 中国医师协会检验医师分会感染性疾病检验医学专家委员会, 徐英春, 张曼. 中国成人艰难梭菌感染诊断和治疗专家共识[J]. 协和医学杂志, 2017, 8(2-3): 131-138. doi: 10.3969/j.issn.1674-9081.2017.03.010

中国成人艰难梭菌感染诊断和治疗专家共识

doi: 10.3969/j.issn.1674-9081.2017.03.010
基金项目: 

卫生公益性行业科研专项 201402001

国家自然科学基金青年科学基金项目 81501807

北京市优秀人才培养资助青年骨干个人项目 2015000020124G071

详细信息
    通讯作者:

    徐英春  电话:010-69159766, E-mail:xycpumch@139.com

    张曼  电话:010-63926389, E-mail:mzhang99@aliyun.com

  • 中图分类号: R516.1;R446

  • 图  1  艰难梭菌感染推荐实验室诊断流程,三步法

    GDH、CCTA、TC、EIAs、NAATs:同表 1;CDI:艰难梭菌感染

    图  2  艰难梭菌感染推荐实验室诊断流程,两步法

    GDH、CCTA、TC、EIAs、NAATs:同表 1;CDI:同图 1

    表  1  艰难梭菌感染不同诊断方法优缺点比较

    检测方法 检测物质 耗时 费用 优点 缺点
    培养 艰难梭菌 1~3 d + 可获得菌株 耗时长,不能区分非产毒株
    GDH 艰难梭菌 1~2 h +++ 简单、快速、敏感度高 不能区分非产毒株
    CCTA 毒素B 1~3 d ++ 金标准 耗时长,技术要求高
    TC 产毒素艰难梭菌 3~5 d ++ 参考方法 耗时长,技术要求高
    毒素EIAs 毒素A/B 1~2 h +++ 简单、快速、特异性高 敏感度低
    NAATs 毒素基因 1~2 h ++++ 快速、敏感度高、特异性高 成本高
    GDH:谷氨酸脱氢酶;CCTA:细胞毒性试验;TC:产毒素培养;EIAs:酶免疫方法;NAATs:核酸扩增试验
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  • [1] Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection[J]. Clin Infect Dis, 2008, 46 Suppl 1:S12-S18. https://academic.oup.com/cid/article/46/Supplement_1/S12/454701
    [2] Carroll KC, Bartlett JG. Biology of Clostridium difficile:implications for epidemiology and diagnosis[J]. Annu Rev Microbiol, 2011, 65:501-521. doi:  10.1146/annurev-micro-090110-102824
    [3] Rodriguez C, Van Broeck J, Taminiau B, et al. Clostridium difficile infection:Early history, diagnosis and molecular strain typing methods[J]. Microb Pathog, 2016, 97:59-78. doi:  10.1016/j.micpath.2016.05.018
    [4] Hawkey PM, Marriott C, Liu WE, et al. Molecular epidemiology of Clostridium difficile infection in a major chinese hospital:an underrecognized problem in Asia?[J]. J Clin Microbiol, 2013, 51:3308-3313. doi:  10.1128/JCM.00587-13
    [5] Ofosu A. Clostridium difficile infection:a review of current and emerging therapies[J]. Ann Gastroenterol, 2016, 29:147-154. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1097/IPC.0000000000000608
    [6] Martin H, Willey B, Low DE, et al. Characterization of Clostridium difficile strains isolated from patients in Ontario, Canada, from 2004 to 2006[J]. J Clin Microbiol, 2008, 46:2999-3004. doi:  10.1128/JCM.02437-07
    [7] Burke KE, Lamont JT. Clostridium difficile infection:a worldwide disease[J]. Gut Liver, 2014, 8:1-6. doi:  10.5009/gnl.2014.8.1.1
    [8] Huang H, Fang H, Weintraub A, et al. Distinct ribotypes and rates of antimicrobial drug resistance in Clostridium difficile from Shanghai and Stockholm[J]. Clin Microbiol Infect, 2009, 15:1170-1173. doi:  10.1111/j.1469-0691.2009.02992.x
    [9] Dubberke ER, Olsen MA. Burden of Clostridium difficile on the healthcare system[J]. Clin Infect Dis, 2012, 55 Suppl 2:S88-S92. doi:  10.1007/978-3-319-72799-8_1
    [10] Bauer MP, Notermans DW, Van Benthem BH, et al. Clostridium difficile infection in Europe:a hospital-based survey[J]. Lancet, 2011, 377:63-73. doi:  10.1016/S0140-6736(10)61266-4
    [11] Camacho-Ortiz A, Lopez-Barrera D, Hernandez-Garcia R, et al. First report of Clostridium difficile NAP1/027 in a Mexican hospital[J]. PLoS One, 2015, 10:e0122627. doi:  10.1371/journal.pone.0122627
    [12] Collins DA, Hawkey PM, Riley TV. Epidemiology of Clostridium difficile infection in Asia[J]. Antimicrob Resist Infect Control, 2013, 2:21. doi:  10.1186/2047-2994-2-21
    [13] Cheng JW, Xiao M, Kudinha T, et al. The First Two Clostridium difficile Ribotype 027/ST1 Isolates Identified in Beijing, China-an Emerging Problem or a Neglected Threat?[J]. Sci Rep, 2016, 6:18834. doi:  10.1038/srep18834
    [14] Yan Q, Zhang J, Chen C, et al. Multilocus sequence typing (MLST) analysis of 104Clostridium difficile strains isolated from China[J]. Epidemiol Infect, 2013, 141:195-199. doi:  10.1017/S0950268812000453
    [15] Tian TT, Zhao JH, Yang J, et al. Molecular Characterization of Clostridium difficile Isolates from Human Subjects and the Environment[J]. PLoS One, 2016, 11:e0151964. doi:  10.1371/journal.pone.0151964
    [16] Dial S, Delaney JA, Barkun AN, et al. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease[J]. JAMA, 2005, 294:2989-2995. doi:  10.1001/jama.294.23.2989
    [17] Bassetti M, Villa G, Pecori D, et al. Epidemiology, diagnosis and treatment of Clostridium difficile infection[J]. Expert Rev Anti Infect Ther, 2012, 10:1405-1423. doi:  10.1586/eri.12.135
    [18] 程敬伟, 徐志鹏, 孙林英, 等.难辨梭菌鉴定培养基临床应用评估[J].临床检验杂志, 2015, 33:554-556. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcjyzz201507018
    [19] Cheng JW, Xiao M, Kudinha T, et al. The role of glutamate dehydrogenase (GDH) testing assay in the diagnosis of Clostridium difficile infections:A high sensitive screening test and an essential step in the proposed laboratory diagnosis workflow for developing countries like China[J]. PLoS One, 2015, 10:e0144604. doi:  10.1371/journal.pone.0144604
    [20] Kufelnicka AM, Kirn TJ. Effective utilization of evolving methods for the laboratory diagnosis of Clostridium difficile infection[J]. Clin Infect Dis, 2011, 52:1451-1457. doi:  10.1093/cid/cir201
    [21] Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections[J]. Am J Gastroenterol, 2013, 108:478-498. doi:  10.1038/ajg.2013.4
    [22] Martin JS, Monaghan TM, Wilcox MH. Clostridium difficile infection:epidemiology, diagnosis and understanding transmission[J]. Nat Rev Gastroenterol Hepatol, 2016, 13:206-216. doi:  10.1038/nrgastro.2016.25
    [23] Crobach MJ, Planche T, Eckert C, et al. European Society of Clinical Microbiology and Infectious Diseases:update of the diagnostic guidance document for Clostridium difficile infection[J]. Clin Microbiol Infect, 2016, 22 Suppl 4:S63-S81. https://www.ncbi.nlm.nih.gov/pubmed/27460910
    [24] Burnham CA, Carroll KC. Diagnosis of Clostridium difficile infection:an ongoing conundrum for clinicians and for clinical laboratories[J]. Clin Microbiol Rev, 2013, 26:604-630. doi:  10.1128/CMR.00016-13
    [25] Kelly CP, Lamont JT. Clostridium difficile-more difficult than ever[J]. N Engl J Med, 2008, 359:1932-1940. doi:  10.1056/NEJMra0707500
    [26] Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults:2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA)[J]. Infect Control Hosp Epidemiol, 2010, 31:431-455. doi:  10.1086/651706
    [27] Bauer MP, Kuijper EJ, Van Dissel JT, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID):treatment guidance document for Clostridium difficile infection (CDI)[J]. Clin Microbiol Infect, 2009, 15:1067-1079. doi:  10.1111/j.1469-0691.2009.03099.x
    [28] Mullane KM, Miller MA, Weiss K, et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections[J]. Clin Infect Dis, 2011, 53:440-447. doi:  10.1093/cid/cir404
    [29] Durai R. Epidemiology, pathogenesis, and management of Clostridium difficile infection[J]. Dig Dis Sci, 2007, 52:2958-2962. doi:  10.1007/s10620-006-9626-y
    [30] Fehér C, Múñez Rubio E, Merino Amador P, et al. The efficacy of fidaxomicin in the treatment of Clostridium difficile infection in a real-world clinical setting:a Spanish multi-centre retrospective cohort[J]. Eur J Clin Microbiol Infect Dis, 2017, 36:295-303. doi:  10.1007/s10096-016-2802-x
    [31] Louie TJ, Miller MA, Mullane KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection[J]. N Engl J Med, 2011, 364:422-431. doi:  10.1056/NEJMoa0910812
    [32] Mattila E, Arkkila P, Mattila PS, et al. Rifaximin in the treatment of recurrent Clostridium difficile infection[J]. Aliment Pharmacol Ther, 2013, 37:122-128. doi:  10.1111/apt.12111
    [33] Di Bella S, Nisii C, Petrosillo N. Is tigecycline a suitable option for Clostridium difficile infection? Evidence from the literature[J]. Int J Antimicrob Agents, 2015, 46:8-12. doi:  10.1016/j.ijantimicag.2015.03.012
    [34] Shah PJ, Vakil N, Kabakov A. Role of intravenous immune globulin in streptococcal toxic shock syndrome and Clostridium difficile infection[J]. Am J Health Syst Pharm, 2015, 72:1013-1019. doi:  10.2146/ajhp140359
    [35] Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection[J]. Clin Infect Dis, 2011, 53:994-1002. doi:  10.1093/cid/cir632
    [36] Van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile[J]. N Engl J Med, 2013, 368:407-415. doi:  10.1056/NEJMoa1205037
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  • 收稿日期:  2017-02-06
  • 刊出日期:  2020-10-30

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