139.4 📌 章末速蚘

  • Risk: antibiotic (clinda, FQ, ceph), age, PPI, hospital
  • Dx: 2-step (GDH + toxin EIA) OR NAAT
  • Severity: WBC 15K + Cr 1.5x = severe; + ileus/megacolon = fulminant
  • Tx initial (2021): Fidaxomicin > Vanco PO > metronidazole (退堎)
  • Fulminant: Vanco PO 500 + Metro IV + surgery consult
  • First recur: fidaxomicin (or vanco taper) + bezlotoxumab
  • Multiple recur: FMT (or Rebyota / Vowst 22E)
  • No alcohol hand gel (spores!)