Treating Initial and Recurrent C. difficile: A Retrospective Analysis of 100 Referred Patients

治疗初次和复发性艰难梭菌感染：100例转诊患者的回顾性分析

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作者：Nevarez-Mejia,Jessica,Trevizani,Raphael,Abawi,Adam,Johansson,Emil,Sutherland,Aaron,Grifoni,Alba,da Silva Antunes,Ricardo,Sette,Alessandro,Muggeo,Paola,Galaverna,Federica,Chiusaroli,Lorenzo,Perruccio,Katia,Coccia,Paola,Baccelli,Francesco,Boccieri,Emilia,Rosignoli,Chiara,De Leonardis,Francesco,Santoro,Nicola,Cesaro,Simone,Mikhailova,Valentina,Marko,Oksana,Mkrtchyan,Edgar,Sokolov,Dmitry,Hincu,Maria Andrada,Nicoara,Doina Alina,Niculet,Elena,Ambrose,Lenuta,Tatu,Alin Laurentiu,Matei,Madalina Nicoleta,Bujoreanu-Bezman,Laura,Nicolescu,Alin Codrut,Negreanu-Pirjol,Ticuta,Tudorache,Sorin,Loghin,Isabela Ioana,Vaţă,Andrei,Rusu,Șerban Alin,Cecan,Ion,Frăsinariu,Otilia-Elena,Dorobăț,Victor Daniel,Hârtie,Vlad,Dorobăţ,Carmen Mihaela,Alexandru,George Cătălin,Gligor,Loredana-Neli,Chioran,Doina,Roi,Ciprian I,Riviș,Mircea,Pricop,Marius Octavian,Urîtu,Andrei,Pacnejer,Aliteia-Maria,Manea,Horațiu Cristian,Olariu,Tudor Rareş,Toyran,Tugba,Bayram,Ertuğrul,Aydınalp Camadan,Yasemin,Sahin,Berksoy,Dalcı,Kubilay,Arslan,Yusuf Kemal,Ergin,Melek,Stoeva,Velina,Kondeva,Veselina,Stoyanova,Rumyana,Martínez-Ramos,Ileana Zorhaya,Pérez-Maroto,Diego,García-Álvarez,Natalia,Barroso,Patricia,García Balbuena,Adan,Núñez-Martínez,Guadalupe,Bottini Luzardo,María Benedicta,García Marín,Juan Francisco,Balseiro,Ana,Láng,Viktória,Adorján,András,Jurkovich,Viktor,Lourenço,Luiz Felipe Crispim,Mendes,Ricardo Evandro,Schoultz,Mariyana,Kirton,Alexandra,Scott,Jason,Flynn,Darren,Beattie,Michelle,Denford,Sarah,Dickens,Geoffrey L,Halawa,Osama M,Ahmed,Esraa,Abdelrazek,Malk M,Nagy,Yasser M,Abdelraouf,Omar A M,An,Longyu,Xu,Zhanyao,Zhang,Xiaoming,Siudak,Zuzanna,Bielański,Paweł,Ropka-Molik,Katarzyna,Piórkowska,Katarzyna,Kowalska,Dorota,Yin,Zhiwu,Chen,Changbin,Wu,Xing,Luo,Wenhao,Quaresma,Paulo,Dai,Jianbiao,Kundnani,Nilima Rajpal,Kumar,Abhijit,Sharma,Abhinav,Mihai,Berceanu Vaduva Marcel,Diana Ardelean,Cristina,Marin-Bancila,Lucretia,Valcovici,Mihaela,Levai,Codrina,Iancu,Adela,Rosca,Ciprian Ilie,Garofalo,Raffaele,Lassandro,Nunzio,Crescenzo,Angelo De,Ranieri,Riccardo,Del Buono,Angelo,Fontanarosa,Alberto,Reyes-Ortiz,Carlos A,Castro-Florez,Ximena,Ocampo-Chaparro,Jose M,Costanzo,Piera,Sciascia,Savino,Quattrocchio,Giacomo,Sbarra,Pierluigi,Barreca,Antonella,Bracci,Roberta,Cecchi,Irene,Radin,Massimo,Menegatti,Elisa,Baldovino,Simone,Passi,Camilla,Novak,Armin Walter,Schneider,Marc,Lee,Sangeun,Xie,Qingchao,Liu,Yihui,Zhang,Zhe,Zhang,Hongmin,Xu,Jin,Wang,Yeru,Zhao,Yong,Rožanec,Jan,Učakar,Veronika,Steyer,Andrej,Pintó Solé,Rosa M,Galičič,An,Nomah,Daniel K,Robles,Alba G,Bruguera,Andreu,Tiraboschi,Juan M,Benet,Susana,García-Pérez,Javier,Jimenez,Paloma,Vilaró,Ingrid,Navarro,Gemma,Sánchez-Palomino,Sonsoles,Suanzes,Paula,Garcia-Gasalla,Mercedes,Homar,Francisco,Mothe,Beatriz,Casabona,Jordi,Reyes-Urueña,Juliana,Buzón,María J,Miro,Jose M,Cagnoli,Giulia,Bertelloni,Fabrizio,Di Paolo,Alessia,Ceccherelli,Renato,Ebani,Valentina Virginia,Márquez-Gómez,Miguel,Prats-Peinado,Lourdes,Díaz,José Antonio Matas,Sánchez-Somolinos,Mar,Guembe,María,Vaquero,Javier,Sanz-Ruiz,Pablo,Alonso-Almorox,Paula,Blanco,Alfonso,Molpeceres-Diego,Ignacio,Grandía-Guzmán,Raiden,Llinás Rueda,Diego,Arbelo,Manuel,Fernández,Antonio,Jabbar,Muhammad,Tharwat,Mohamed,Younus,Muhammad,Tariq,Muhammad,Mousa,Abdallah A,Alkhedhairi,Saleh,Pine,Klavio,Pine,Vivian,Negrut,Nicoleta,Ferician,Anca,Marian,Paula,Tabora-Sarmiento,Shisbeth,Sinkway,Thomas D,Robinson,Sarah E,Paneque,Francisco,Winn,Nicole,Cheramy,Jeantel,Cottler,Linda B,Bowden,John A,Sabo-Attwood,Tara,Bisesi,Joseph H Jr,Li,Siqi,Li,Xiaoyu,Feng,Yuan,Ding,Xiaolei,Ye,Jianren,Pei,Yuchen,Seltzer,Jaime,Grach,Stephanie L,Eggers,Scott D,Redetzke,Melissa M,Mau,Katie J,Chon,Tony Y,Ganesh,Ravindra,Mahrous,Nahed N,Fallatah,Mohannad M,Fitaihi,Rawan A,Aldahshan,Hala,Alhhazmi,Areej A,Al-Khaldi,Samiyah,Fallatah,Hussam,Althobaiti,Abdulmajeed A,Alkhoshaiban,Abdulaziz Saleh,Alguraini,Jawaher,Aldkheil,Esraa A,Jamous,Yahya F,Pavone,Silvia,Montagnin,Clara,Iscaro,Carmen,Ranucci,David,Feliziani,Francesco,Danese,Tommaso,Valle,Emanuela,Lamanna,Martina,Colleluori,Riccardo,Buonaiuto,Giovanni,Fusaro,Isa,Cavallini,Damiano,Li,Zhenyang,Wang,Xinyuan,Jiang,Lin,Jin,Kexin,Feng,Zhaoyang,Xu,Jie,Shen,Yesheng,Meng,Fanliang,Qiu,Jianhua,Li,Ning,Liu,Sidang,Wang,Gang,Zhang,Jingpeng,Zhang,Dingding,Jiang,Jinxiu,Lin,Yusheng,Wan,Chunhe,Che,Yongliang,Ahn,Tae Kun,Kwack,Won Gun,Im,So Young,Moon,Seo Hyeon,Park,Seok Jun,Park,Ki-Ho,Chung,Eun Kyoung,Zhang,Botong,Guo,Sainan,Li,Mingyu,Niu,Yuan,Liu,Yiman,Wu,Nan,Zhu,Hong,Cui,Yue,Liu,Xiaoyan,Wang,Lijuan,Xing,Chunyu,Liu,Haiyan,Luo,Guanghong,Yang,Shenghui,Xia,Qiqi,Liu,Jian,Gui,Yaping,Xia,Luming,Cao,Chuangui,Chen,Beijuan,Yu,Xiangqian,Chen,Weifeng,Xu,Feng,Wang,Jian,Zhao,Hongjin,Enciu,Bianca Georgiana,Popescu,Rodica,Zaharia,Alina Daniela,Schimmer,Barbara,Pițigoi,Daniela,Sîrbu,Anca Mirela,Pistol,Adriana,Tan,Ade Xin Ning,Hussin,Ilyas,Chong,Chia Yin,Maiwald,Matthias,Chiong,Terri Xiao-Bei,Tan,Natalie Woon Hui,Li,Li,Xu,Yingying,Yang,Junjie,Feng,Helong,Wang,Hongcai,Zeng,Zhe,Yao,Lun,Luo,Qingping,Wen,Guoyuan,Cheng,Guofu,Shang,Yu,Le Breton,Cléa,Klopfenstein,Timothée,Zayet,Souheil,Latkin,Carl A,Dayton,Lauren,Bhaktaram,Ananya,Davey-Rothwell,Melissa A,Bonneau,Haley,Yi,Grace Tian,Falade-Nwulia,Oluwaseun,Nguyen,Benjamin H,Stanley,Elise,Baxter,Victoria K,Griffin,Diane E,Stacey,Samantha P,Mounce,Bryan C,Kim,Hee Ho,Kim,Kwangwook,Kim,Min Jung,Yang,Ye Jin,Choi,Eun Bee,Heo,Ji Woong,Moon,Seo Young,Lim,Heeji,Lee,Yookyoung,Ouh,In-Ohk,Park,Kwang Il,Büyüker,Sultan Mehtap,Khan,Khizar Abdullah,Khalil,Abdul Qadeer Khan,Khan,Imran,Jahan,Shah,Adil,Muhammad,Al-Rohily,Khalid M,Al-Khamees,Abdulmoneem H,Khalil,Atif Ali Khan,Essadki,Yasser,Zerrifi,Soukaina El Amrani,Carvalho,Maria de Fátima,Barros,Lillian,Vasconcelos,Vitor,Campos,Alexandre,Khalloufi,Fatima El,Oudra,Brahim,Martins,Rosário,Laza,Ruxandra,Luput-Andrica,Ioana-Melinda,Marinescu,Adelina-Raluca,Cut,Talida-Georgiana,Herlo,Alexandra,Saizu,Andra-Elena,Floruncut,Andreea-Cristina,Nicolescu,Narcisa,Jumanca,Romanita,Rosoha,Daniela-Ica,Lazureanu,Voichita Elena,Ana-Maria,Romosan,Kabir,Abdul,Kamboh,Asghar Ali,Abubakar,Muhammad,Lionel,Kinkpe,Matar,Abdulkareem Mohammed,Qin,Xinyu,Shao,Zongti,Yu,Binbin,Cao,Rongji,Zhang,Haipeng,Shi,Liyuan,Liu,Pan,Zi,Shaogui,Yang,Jiao,Long,Ying,Liu,Cong,Yan,Siyu,Yang,Xiaoxia,Zhu,Zhengling,Zhong,Youhong,Wang,Peng,Torre,Ricarda,Pinto da Silva,Luís,Albalawi,Yazeed,Zubair,Mohammad,Kalabikhina,Irina Evgenievna,Kolotusha,Anton Vasilyevich,Moshkin,Vadim Sergeevich,Echeverri,Lina,Lopez,Ana Lucia,Posso,Diego Orlando,Hubloue,Ives,Ragazzoni,Luca,Salio,Flavio,Poovorawan,Yong,Kanokudom,Sitthichai,Nilyanimit,Pornjarim,Puenpa,Jiratchaya,Yang,Xiao,Ma,Hui,Zhu,Min,Song,Xinyu,Feng,Jiahao,Vengušt,Gorazd,Vengušt,Diana Žele,da Silva,Beatriz Pires,Fontoura,Pablo Secato,Daniel-Ribeiro,Cláudio Tadeu,Ferreira-da-Cruz,Maria de Fátima,Raut,Neha,Chaudhary,Anis A,Patil,Harshad,Shidhaye,Supriya,Khobragade,Ruchi,Umekar,Milind,Ali,Mohamed A M,Trivedi,Rashmi,Chițu,Marius-Costin,Caragea,Daniel-Cosmin,Pălimariu,Carmen-Marina,Salmen,Teodor,Marcu,Radu-Dragoș,Cimpeanu,Radu-Cristian,Spînu,Dan-Arsenie,Jinga,Viorel,Stoian,Anca Pantea,Mischianu,Dan Liviu Dorel,McDermott,Mollie,Sarkar,Shamim,O’Brien,Janice,Gruszynski,Karen,Shock,Barbara,Faulkner,Vina,Wisnieski,Lauren,Stankūnaitė,Aistė,Ribikauskas,Vytautas,Morkūnaitė,Justina,Kučinskienė,Jūratė,Corrêa-Moreira,Danielly,Barreira,Thais Guimarães,Castro,Rodolfo,Borba,Cintia de Moraes,Evangelista Oliveira,Manoel Marques,Sonnenholzner-Varas,Jorge I,Panchana,María,Searcy-Bernal,Ricardo,Sambri,Andrea,Bruschi,Alessandro,Scollo,Cristina,De Paolis,Massimiliano,Naranjo-Ortíz,María F,Parada-Rubio,Luz,Fuentes-Montoya,José,Poveda,Jean Carlos Villamil,Torres-Suarez,Francy Elaine,Martínez-Díaz,Heidy-C,Ortiz,Laura Daniela Ardila,Velosa-Porras,Juliana,Jaramillo,Lorenza,Castillo,Jorge Andrés,Jaime,Jairo,Roa,Nelly S,Corredor-Figueroa,Adriana P,Hu,Lanxin,Duan,Hongyu,Zhang,Yu,Yang,Liang,Yoon,Kyung Chul,Shen,Zihan,Li,Zekai,Ma,Baikai,Qi,Hong,Ilardo,Martina,Sapienza,Marco,de Cristo,Claudia,Musumeci,Maria Agata,Torrisi,Paola,Di Paola,Noemi,Caldaci,Alessia,Vescio,Andrea,Canavese,Federico,Pavone,Vito,Testa,Gianluca,Severin,Florentina,Andoni,Andrei Alexandru,Serban,Raluca Ioana,Nicolau,Andrei,Mereuta,Deniss Vasile,Vlad,Andreea,Mocanu,Florin,Roman,Ionut Andrei,Palade,Octavian Dragos,Al-Hakami,Hadi Afandi,Abdullah,Ismail A,Almutairi,Nora S,Aldawsari,Rimaz R,Alluqmani,Ghadah Ali,Fallatah,Halah Ahmed,Alsulami,Yara Saud,Alasiri,Elyas Mohammed,Alsufyani,Rahaf D,Alorabi,Raghad Ayman,Aldainiy,Reffal Mohammad,Biçengil,Kader,Kurt,Ayça,Naralan,Muhammed Enes,Okumuş,İrem,Catalani,Filippo,Pannunzio,Arianna,Valeriani,Emanuele,Ageno,Walter,Pignatelli,Pasquale,Györik,Sandor,Franco,Alessandra,Angelone,Francesca,Calderone,Danilo,Ponsiglione,Alfonso Maria,Romano,Maria,Ricciardi,Carlo,Amato,Francesco,Mao,Xuming,Konigsberg,Jake,Noorchashm,Nadia,Meng,Wenzhao,Knox,James J,Golden,Gregory J,Hamilton,Jacob T,Maxwell,Tara K,Liu,Chengyang,Betts,Michael R,Willi,Steven M,Naji,Ali,Hanley,Patrick,Luning Prak,Eline T,Basheer,Aseel,Khiabani,Parisa Masnadi,Jentner,Wolfgang,Wendelboe,Aaron,Vogel,Jason R,Kuhn,Katrin Gaardbo,Wimberly,Michael C,Hougen,Dean,Ebert,David,Lescaie,Andreea,Nitescu,Gabriela Viorela,Stratula,Andreea Catalina,Boghițoiu,Dora Andreea,Vivisenco,Cristina Iolanda,Manolache,Andreea,Cotuna,Diana Georgiana,Mitrea,Alina,Rad,Florina,Zhu,Xuerui,Chen,Xinlin,He,Le,Zhu,Linhe,Ahamad,Rizwan,Mubin,Nida,Alnukhali,Mohammed,Akhtar,Mohd,Aqil,Mohd,Mujeeb,Mohd,Ahmad,Anis,Dilonardo,Elena,King,Sarah R B,McLean,Amy,Hennig,Jacob D,Schoenecker,Kathryn 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Maria,Iftimie,Nicolae Florin,Segura-Sampedro,Juan José,Cadar,Ramona,Buzincu,Iulian,Davidescu,Alexandra,Nastase,Anda Lucia,Briceanu,Oana Georgiana,Lupascu-Ursulescu,Corina,Lupascu,Cristian Dumitru,Radu-Adameşteanu,Mădălina Olivia,Dragu,Elena Rodica,Chioaru,Bogdan Liviu,Ţânţu,Ana Cătălina,Ene,Corina Daniela,Creţu,Andrei,Georgescu,Camelia Andreea,Hariga,Cristian Sorin,Pițuru,Maria-Teodora,Apetroaei-Leucă,Miruna-Maria,Ștefan,Gabriela,Șonea,Cosmin,Tăpăloagă,Dana,Velescu,Bruno Ștefan,Arsene,Andreea Letiția,Udeanu,Denisa Ioana,Nedea,Marina Ionela,Vlăgioiu,Constantin,Zhang,Wei,Wong,Catherine W Y,Zhang,Richard,Tian,Renmao,Imanian,Behzad,Li,Yan,Jiang,Hongmei,Kusuma,Sri Agung Fitri,Anggraeni,Santi Rukminita,Sari,Qurnia Wulan,Sofyana,Neng Tanty,Sodnomdavaa,Tsolmon,Gantumur,Uyanga,Hung,Jui-Ying,Deng,Cai-Qin,Cheng,Wen-Jie,Wang,Yuan-Lan,Wang,Yi-Dan,Zou,Feng-Cai,Zhu,Xing-Quan,Li,Zhao,Faustino,Margot,Flores,Carlos Alonso,Málaga-Machaca,Edith 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期刊：影响因子：
时间：2026起止号：2026 Apr;14(4)
doi：10.64898/2026.04.14.718521

Abstract

Treatment guidelines for Clostridioides difficile infection (CDI) have been published by infectious disease and gastroenterology professional societies; however, adherence in clinical practice remains poorly characterized, particularly for recurrent disease. We conducted a retrospective chart review of 100 patients with CDI (350 episodes: 115 initial, 235 recurrent) referred to a tertiary complicated CDI clinic between 2018 and 2023. Guideline adherence was assessed by comparing treatment with IDSA/SHEA and ACG recommendations, and referring diagnoses were compared with final specialist diagnoses. Guideline adherence was significantly higher in initial compared to recurrent episodes (70.4% vs. 41.3%, p < 0.0001). Among guideline non-adherent recurrent episodes, 51.3% used standard antibiotic regimens inappropriate for the recurrence tier. Specialist review reclassified 12.0% of episodes, with colonization increasing from 2.6% to 8.9%. Misdiagnosed colonization cases had a 6.2-fold higher treatment failure rate than confirmed CDI (39.3% vs. 6.3%, p < 0.0001). Guideline non-adherence showed a non-significant trend toward treatment failure (10.0% vs. 6.7%, p = 0.31). Guideline adherence for recurrent CDI is inadequate in pre-referral settings, and diagnostic misclassification is common. Early specialist involvement may improve both diagnostic accuracy and treatment appropriateness for patients with recurrent CDI.

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