Abstract：
Clostridioides difficile infection (CDI) remains a significant clinical challenge both in the management of severe and severe-complicated disease and the prevention of recurrence. Guidelines released by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America (IDSA/SHEA) and ESCMID had some consensus as well as some discrepancies in disease severity classification and treatment recommendations. We review and compare the key clinical strategies from updated IDSA/SHEA, ESCMID and current Australasian guidelines for CDI management in adults and discuss relevant issues for clinicians, particularly in the management of severe-complicated infection. Updated IDSA/SHEA and ESCMID guidelines now reflect the increased efficacy of fidaxomicin in preventing recurrence and have both promoted fidaxomicin to first-line therapy with an initial CDI episode in both non-severe and severe disease and endorsed the role of bezlotoxumab in the prevention of recurrent infection. Vancomycin remains acceptable therapy and metronidazole is not preferred. For severe-complicated infection the IDSA/SHEA recommends high-dose oral ± rectal vancomycin and IV metronidazole, whilst in an important development, ESCMID has endorsed fidaxomicin and tigecycline as part of combination anti-CDI therapy, for the first time. The role of faecal microbiota transplantation (FMT) in second CDI recurrence is now clearer, but timing and mode of FMT in severe-complicated refractory disease still requires further study.
摘要：
艰难梭菌感染（CDI）在治疗严重和严重复杂的疾病以及预防复发方面仍然是重要的临床挑战。美国传染病学会和美国医疗保健流行病学学会（IDSA/SHEA）和ESCMID发布的指南在疾病严重程度分类和治疗建议方面达成了一些共识，也存在一些差异。我们回顾并比较了更新的IDSA/SHEA的关键临床策略，ESCMID和当前的澳大利亚成人CDI管理指南，并讨论临床医生的相关问题，特别是在严重复杂感染的管理中。更新的IDSA/SHEA和ESCMID指南现在反映了非达霉素在预防复发方面的功效增强，并且在非严重和严重疾病中均促进了非达霉素在初始CDI发作时的一线治疗，并认可了bezlotoxumab在预防复发感染中的作用。万古霉素仍然是可接受的治疗，甲硝唑不是优选的。对于严重复杂的感染，IDSA/SHEA建议大剂量口服±直肠万古霉素和静脉注射甲硝唑，在一个重要的发展中，ESCMID已认可非达霉素和替加环素作为抗CDI联合治疗的一部分，第一次。粪便微生物移植（FMT）在第二次CDI复发中的作用现在更加清晰，但FMT在重症难治性疾病中的时机和模式仍需进一步研究。
