Clostridioides difficile-associated disease
小结
定义
病史和体格检查
关键诊断因素
- diarrhea
- abdominal pain
其他诊断因素
- fever
- abdominal tenderness
- nausea and vomiting
- abdominal distension
- symptoms of shock
危险因素
- antibiotic exposure
- advanced age
- hospitalization or residence in a nursing home
- exposure to infected family member
- history of Clostridioides difficile-associated disease
- use of acid-suppressing drugs
- inflammatory bowel disease
- solid organ transplant recipients
- hematopoietic stem cell transplant recipients
- chronic kidney disease
- HIV infection
- immunosuppressive agents or chemotherapy
- gastrointestinal surgery
- vitamin D deficiency
- consumption of C difficile contaminated food
诊断性检查
首要检查
- CBC
- stool guaiac (fecal occult blood test)
- stool polymerase chain reaction (PCR)
- stool immunoassay for glutamate dehydrogenase
- stool immunoassay for toxins A and B
- abdominal x-ray
需考虑的检查
- cell culture cytotoxicity neutralization assay
- CT abdomen
- sigmoidoscopy or colonoscopy
新兴检查
- stool lactoferrin or calprotectin
治疗流程
initial episode: nonsevere
initial episode: severe
initial episode: fulminant
first recurrence
subsequent recurrence
撰稿人
作者
Ali Hassoun, MD, FACP, FIDSA, AAHIVS
Clinical Associate Professor of Medicine
Alabama Infectious Diseases Center
Huntsville
AL
利益声明
AH declares that he has no competing interests.
同行评议者
Gregory R. Madden, MD, MSDS
Assistant Professor
Division of Infectious Diseases and International Health
University of Virginia School of Medicine
Charlottesville
VA
利益声明
GRM declares that he has no competing interests.
Satish Keshav, MBBCh, DPhil, FRCP
Consultant Gastroenterologist
Department of Gastroenterology
John Radcliffe Hospital
Oxford
UK
利益声明
SK declares that he has no competing interests.
Ian Beales, MD, FRCP
Clinical Reader and Consultant Gastroenterologist
Norfolk and Norwich University Hospital
Norwich
UK
利益声明
IB declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):e1-48.全文 摘要
Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on Management of Clostridioides difficile infection in adults. Clin Infect Dis. 2021 Jun 24:ciab549.全文 摘要
Nelson RL, Suda KJ, Evans CT. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev. 2017;(3):CD004610.全文 摘要
van Prehn J, Reigadas E, Vogelzang EH, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin Microbiol Infect. 2021 Dec;27 Suppl 2:S1-S21.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Antibiotic-associated diarrhea (AAD)
- Ischemic colitis
- Bacterial or viral gastroenteritis
更多 鉴别诊断指南
- Guideline for the management of Clostridioides difficile infection in pediatric patients with cancer and hematopoietic stem-cell transplantation recipients
- Fecal microbiota-based therapies for select gastrointestinal diseases
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