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Tackling the recurrence of Clostridium difficile infection

机译：解决梭菌差异感染的复发

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The pathogenesis of recurrent Clostridium difficile infection (CDI) is still poorly understood. The risk of recurrence is approximately 20% after an initial CDI episode and dramatically increases with subsequent CDI recurrences. Several factors may play a role in recurrent CDI (rCDI), including conditions influencing germination, metabolic pathways that influence toxin production of C. difficile, and the microbiota composition offering protection against colonization and disease caused by C. difficile. Paradoxically, the currently recommended treatment for acute symptomatic CDI, i.e. metronidazole or vancomycin, can cause modification of the intestinal flora. Indeed, administration of anti-CDI antibiotics leads to suppression of C. difficile, along with collateral damage of the protective intestinal microbiota and opening of a "window of vulnerability" for recurrence. Host factors also have a prominent role, including innate and acquired humoral immunity, i.e. passive antibodies administration or active vaccination as a prevention strategy. They play a crucial role in the protection against severe and recurrent CDI. The assessment of risk factors of recurrence and modeling prediction scores could help in preventing the troublesome experience of CDI recurrence. Six studies have methodologically assessed prediction scores for rCDI. However, the definition of recurrence was heterogeneous, external validation was often not performed, and immunological factors were often not considered. There is a need for further studies on the pathophysiology of recurrence to design models for prediction that are sound and applicable in clinical practice. (C) 2017 Elsevier Masson SAS. All rights reserved.
机译：复发性梭菌差异感染（CDI）的发病机制仍然不明显。在初始CDI发作后复发的风险约为20％，随后的CDI复发性显着增加。若干因素可能在复发性CDI（RCDI）中发挥作用，包括影响萌发的条件，影响毒素的衍生C.艰难梭菌和微生物群组合物提供保护免受由C.艰难梭菌引起的殖民化和疾病的保护。矛盾的是，目前推荐的急性症状CDI治疗，即甲硝唑或万古霉素，可导致肠道菌群的改性。实际上，抗CDI抗生素的给药导致抑制C.艰难梭菌，以及保护性肠道微生物群的侧面损伤，并为复发的“脆弱性窗口”的开放。宿主因子也具有突出的作用，包括先天性和获得的体液免疫力，即被动抗体给药或接种疫苗接种作为预防策略。他们在防止严重和经常性CDI的保护方面发挥着至关重要的作用。复发和建模预测分数的风险因素评估有助于防止CDI复发的麻烦体验。六项研究对RCDI进行了方法论评估了预测分数。然而，复发的定义是异质的，通常没有进行外部验证，并且通常不考虑免疫因素。需要进一步研究对临床实践中的预测设计模型的复发性的病理生理学。 （c）2017年Elsevier Masson SAS。版权所有。

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