Tom 11, Nr 2 (2019)
Artykuły
Opublikowany online: 2019-09-23
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Diagnostyka, profilaktyka i leczenie infekcji Clostridium difficile według wytycznych Infectious Diseases Society of America (IDSA) i Society for Healthcare Epidemiology of America (SHEA) z 2017 roku
Gastroenterologia Kliniczna 2019;11(2):43-54.
Streszczenie
W artykule omówiono nowe wytyczne dotyczące diagnostyki, profilaktyki i leczenia infekcji Clostridium difficile, opublikowane w 2018 roku przez Amerykańskie Towarzystwo Chorób Zakaźnych (IDSA) i Amerykańskie Towarzystwo Opieki Zdrowotnej (SHEA). Clostridium difficile jest najczęstszą przyczyną biegunki poantybiotykowej oraz zakażenia wewnątrzszpitalnego. Dlatego diagnozowani w jego kierunku powinni być wszyscy pacjenci z biegunką, którzy w ciągu ostatnich trzech miesięcy otrzymywali antybiotyki, lub byli hospitalizowani. Do innych czynników ryzyka należą przewlekła choroba nerek, cukrzyca, stan po transplantacji narządu (z towarzyszącą immunosupresją), stosowanie inhibitorów pompy protonowej. Podstawą diagnostyki jest stwierdzenie obecności dehydrogenazy mleczanowej (GDH) w stolcu w połączeniu z testem na obecność toksyny A i B. Nowe wytyczne redukują rolę metronidazolu w leczeniu infekcji C. difficile i ustanawiają wankomycynę lekiem pierwszego wyboru już w pierwszym epizodzie zachorowania. Alternatywą dla wankomycyny jest fidaksomycyna. Ważną nowością jest zastosowanie ryfaksyminy w leczeniu drugiego i kolejnych nawrotów. Podkreśla się także rolę przeszczepienia stolca w leczeniu nawrotowej infekcji C. difficile.
Słowa kluczowe: infekcja Clostridium Difficilerozpoznawanieleczenie
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