在全原造血细胞移植接受者中发生的Clostridioides difficile感染
Davide Lo Porto1, Alessandra Mularoni1, Elio Castagnola2
1Unit of Infectious Diseases, IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy.
概括
艰难菌感染 (CDI) 是所有基性造血细胞移植 (allo-HCT) 患者的严重风险. 目前成人治疗方法包括菲达克索米辛和万科米辛,以及贝兹洛托克苏马布以预防复发.
科学领域:
- 传染性疾病 传染性疾病
- 血液学 血液学 血液学
- 胃肠病学 胃肠病学
背景情况:
- 困难闭膜炎 (CD) 是住院患者腹的主要原因.
- 异质造血细胞移植 (allo-HCT) 接受者因住院,免疫抑制和抗生素而面临CD感染 (CDI) 的风险增加.
- CDI可能严重影响alo-HCT患者,延长住院时间,影响肠道微生物群,并恶化结果.
研究的目的:
- 审查成年和儿科患者进行全源造血细胞移植 (allo-HCT) 的Clostridioides difficile感染 (CDI) 的诊断和管理.
- 讨论当前的治疗指导方针和新兴的治疗方法,对CDI在这个弱势群体.
主要方法:
- 目前文献和临床指导方针的综述,用于CDI的诊断和治疗.
- 对成人和儿科患者群体的治疗建议的分析,包括一线药物,替代品和复发预防.
主要成果:
- 在成年人中,建议第一线使用菲达克索米辛,替代品是万科米辛. 贝兹洛托克苏马布可以预防复发.
- 儿科治疗主要使用万科米辛和美特罗尼达,尽管预计菲达克索米辛将成为标准.
- 便微生物群移植通常不推给所有HCT患者,因为安全性数据有限.
结论:
- CDI是alo-HCT患者的重大并发症,需要仔细诊断和管理.
- 成人和儿科患者的治疗策略有所不同,建议也在不断变化.
- 需要对新型疗法进行进一步的研究,例如便微生物群移植在 allo-HCT 背景下.
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