{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:33:17Z","timestamp":1767339197508,"version":"3.37.3"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>\n            Epidemiologie In einer aktuellen epidemiologischen Arbeit zeigt sich ein seit 2013 r\u00fcckl\u00e4ufiger Trend von Clostridioides-difficile-Infektionen (CDI) in Deutschland, zusammen mit einer Abnahme des Anteils hypervirulenter Ribotypen (vor allem RT 027 und RT 078). Dennoch bleibt die Krankheitslast hoch und insbesondere \u00e4ltere und vorerkrankte Patientinnen und Patienten sind h\u00e4ufig betroffen. Aktuelle US-amerikanische Daten zeigen, dass bei \u00e4lteren Patientinnen und Patienten insbesondere CDI-Rezidive, assoziierte psychiatrische Diagnosen wie Depressionen sowie Folgeerkrankungen wie Sepsis eine hohe Krankheitslast f\u00fcr Betroffene darstellen.<\/jats:p><jats:p>\n            Mikrobiologie Neue Studien liefern Erkenntnisse zum Zusammenspiel von C. difficile mit anderen Darmpathogenen; so scheinen Koinfektionen mit Enterokokken zu einer erh\u00f6hten Virulenz von C. difficile beizutragen.<\/jats:p><jats:p>\n            Neue europ\u00e4ische Therapieleitlinie Nach der 2021 aktualisierten ESCMID-Leitlinie ist Fidaxomicin aufgrund des geringeren Rezidivrisikos Mittel der ersten Wahl f\u00fcr erstmalig auftretende und rezidivierende CDI. Metronidazol dagegen sollte nur dann zum Einsatz kommen, wenn weder Fidaxomicin noch Vancomycin zur Verf\u00fcgung stehen. Die f\u00e4kale Mikrobiota-Transplantation (FMT) hat sich im Rahmen eines individuellen Heilversuchs zur Behandlung mehrfach rezidivierender CDI etabliert; allerdings wurden die regulatorischen Auflagen daf\u00fcr im Zuge der Corona-Pandemie weiter versch\u00e4rft. Auch bei refrakt\u00e4r verlaufender fulminanter CDI kann die FMT als Alternative zur chirurgischen Intervention erwogen werden.<\/jats:p><jats:p>\n            Weitere Behandlungsm\u00f6glichkeiten Mit dem Small-Molecule-Antibiotikum Ridinilazol k\u00f6nnte in Zukunft neben Fidaxomicin ein weiteres CDI-Antibiotikum mit schmalem Wirkspektrum und kaum enteraler Resorption zur Verf\u00fcgung stehen. Die orale Mikrobiota-Therapie mittels aufgereinigter Firmicutes-Sporen (SER-109) zeigte in einer aktuellen Phase-III-Studie vielversprechende Ergebnisse und k\u00f6nnte in Zukunft durch die Anwendung in oralen Kapseln eine unkomplizierte Alternative zur FMT darstellen.<\/jats:p><jats:p>\n            Toxoid-Impfstoff Die Hoffnungen auf einen gut wirksamen Toxoid-Impfstoff zur Prim\u00e4r- und Sekund\u00e4rpr\u00e4vention von CDI haben sich in der CLOVER-Studie leider nicht erf\u00fcllt.<\/jats:p>","DOI":"10.1055\/a-1970-9211","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T22:46:05Z","timestamp":1685573165000},"page":"752-758","source":"Crossref","is-referenced-by-count":1,"title":["Clostridioides difficile \u2013 Neue Erkenntnisse und Therapieempfehlungen"],"prefix":"10.1055","volume":"148","author":[{"given":"Sebastian","family":"Sch\u00f6nherr","sequence":"additional","affiliation":[{"name":"Bereich Infektiologie und Tropenmedizin, Klinik und 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