139.3 🩺 內科專科考前版

139.3.0.1 1️⃣ 22E 更新

• Fidaxomicin preferred (lower recurrence vs vanco)
• Bezlotoxumab (Zinplava) add-on for high-recurrence-risk: ≥ 65 yo, severe CDI, prior CDI, immunocompromised
• Rebyota (RBL2660) FDA 2022; Vowst (SER-109) FDA 2023 — replacing crude FMT for recurrent CDI
• Hypervirulent strain (ribotype 027 / NAP1 / BI): 加重 epidemic; toxin B 1000× toxic; resistance to FQ
• Antibiotic stewardship: best CDI prevention

139.3.0.2 2️⃣ 預防

• Antimicrobial stewardship: minimize broad-spectrum
• Contact precautions for CDI patients (single room, gloves/gown)
• Soap + water hand washing (alcohol gel 不殺 spores!)
• Hospital cleaning: sporicidal (bleach 1:10)
• No probiotics routine (not recommended for prevention 2021 ACG)

139.3.0.3 3️⃣ 台灣 context

• CDI prevalence rising (aging + antibiotic overuse)
• 健保 Fidaxomicin 有條件給付 (high-risk recurrence, biological agent users, severe)
• FMT available in major medical centers; 多 colonoscopy delivery
• Pseudomembrane diagnostic at sigmoidoscopy 仍是 visual gold standard

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