艱難梭菌感染：持續(xù)的挑戰(zhàn)20xx0627sific(編輯修改稿)
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【文章內(nèi)容簡介】 ress testing concerns. More data on utility are necessary before this methodology can be recommended for routine testing. (BII),第五十頁，共七十六頁。,【挑戰(zhàn)3】 治療： 不能早期診斷(zhěndu224。n)，起始治療常被耽誤！,第五十一頁，共七十六頁。,治療(zh236。li225。o)方式,立即停用造成腹瀉(f249。xi232。)的抗生素 補(bǔ)充水分以及電解質(zhì) 如有必要再加以藥物的治療，如口服或靜脈注射甲硝唑Metronidazole或是萬古霉素Vancomycin,第五十二頁，共七十六頁。,C. difficile – Antibiotic Risk,High Risk Antibiotics: Cefotaxime Ceftriaxone Cefalexin Cefuroxime Ceftazidime Ciprofloxacin Moxifloxacin Clindamycin (low dose),Medium Risk Antibiotics: Meropenem Ertapenem Clindamycin (high dose) Coamoxiclav Tazocin Erythromycin Clarithromycin,第五十三頁，共七十六頁。,C. difficile – Antibiotic Risk,Low Risk Antibiotics: Benzyl penicillin Gentamicin Amoxicillin Metronidazole Flucloxacillin Vancomycin Tetracyclines Teicoplanin Trimethoprim Synercid Nitrofurantoin Linezolid Fusidic acid Tigecycline Rifampicin Daptomycin,第五十四頁，共七十六頁。,IV. Treatment: Does the choice of drug for CDI matter and, if so, which patients should be treated and with which agent?,25. Discontinue therapy with the inciting antimicrobial agent(s) as soon as possible, as this may in?uence the risk of CDI recurrence (AII). 26. When severe or complicated CDI is suspected, initiate empirical treatment as soon as the diagnosis is suspected (CIII). 27. If the stool toxin assay result is negative, the decision to initiate, stop, or continue treatment must be individualized (CIII). 28. If possible, avoid use of antiperistaltic agents, as they may obscure symptoms and precipitate toxic megacolon (CIII).,Cohen SH, et al. Clinical Practice Guidelines for Clostridium dif?cile Infection in Adults: 2022 Update by SHEA and IDSA. Infect Control Hosp Epidemiol 2022。 31(5):431455,第五十五頁，共七十六頁。,29. Metronidazole is the drug of choice for the initial episode of mildtomoderate CDI. The dosage is 500 mg orally 3 times per day for 10–14 days. (AI) 30. Vancomycin is the drug of choice for an initial episode of severe CDI. The dosage is 125 mg orally 4 times per day for 10–14 days. (BI) 31. Vancomycin administered orally (and per rectum, if ileus is present) with or without intravenously administered metronidazole is the regimen of choice for the treatment of severe, complicated CDI. The vancomycin dosage is 500 mg orally 4 times per day and 500 mg in approximately 100 mL normal saline per rectum every 6 hours as a retention enema保存(bǎoli)灌腸 , and the metronidazole dosage is 500 mg intravenously every 8 hours. (CIII),Cohen SH, et al. Clinical Practice Guidelines for Clostridium dif?cile Infection in Adults: 2022 Update by SHEA and IDSA. Infect Control Hosp Epidemiol 2022。 31(5):431455,第五十六頁，共七十六頁。,32. Consider colectomy for severely ill patients. Monitoring the serum lactate level and the peri
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