Recurrent infection-clostridioides difficile infection

(15–30% risk after d/c of abx, most w/in 2 wk of stopping abx)

• 1st recurrence: fidaxomicin 200 mg PO bid × 10 d or vanco 125 mg PO q6h × 10–14 d. Consider adding bezlotoxumab 10 mg/kg IV × 1 during abx Rx (mAb that binds toxin B) as ↓ recurrence; caution in CHF (NEJM 2017;376:305).

• Subsequent recurrences: fidaxomicin or vanco PO pulse → taper. Consult ID. Fecal microbial transplant (JAMA 2017;318:1985) recommended after 3 CDI.

• Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection | NEJM

• Prevention: vanco 125 mg PO QD ↓ risk of recurrence (CID 2016;65:651); consider for Pts needing abx w/ h/o severe or recurrent CDI. Avoid acid suppression/abx as able.

fecal microbiota transplantation

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The first paragraph is discussing the risk of recurrent Clostridioides difficile infection (CDI) after a course of antibiotics. The risk is 15-30%, and most recurrences occur within 2 weeks of stopping the antibiotics. The paragraph then goes on to discuss treatment options for first and subsequent recurrences. For first recurrences, the recommended treatment is either fidaxomicin or vancomycin. Bezlotoxumab may also be considered as it has been shown to decrease recurrence rates. However, caution should be used in patients with congestive heart failure. For subsequent recurrences, the recommended treatment is either fidaxomicin or vancomycin given in a pulsed dose followed by a taper. Fecal microbiota transplantation is recommended after 3 CDI recurrences.

The second paragraph is discussing prevention of CDI recurrences. Vancomycin given once daily has been shown to decrease the risk of recurrence. It is recommended for patients who need antibiotics and have a history of severe or recurrent CDI. Acid suppression and antibiotics should be avoided if possible.

窩的英文不太好

第一段討論抗生素療程後艱難梭菌感染 (CDI) 復發的風險。風險為 15-30%，大多數復發發生在停用抗生素後 2 週內。該段然後繼續討論第一次和隨後復發的治療方案。對於首次復發，推薦的治療方法是非達黴素或萬古黴素。 Bezlotoxumab 也可以考慮，因為它已被證明可以降低復發率。但是，充血性心力衰竭患者應謹慎使用。對於隨後的複發，推薦的治療是非達黴素或萬古黴素以脈沖劑量給藥，然後逐漸減量。 3 次 CDI 復發後，建議進行糞便微生物群移植。

第二段討論 CDI 復發的預防。每天給予一次萬古黴素已被證明可以降低復發風險。建議需要抗生素且有嚴重或複發性 CDI 病史的患者使用。如果可能，應避免抑酸和抗生素。