Clostridium difficile — a growing diagnostic and therapeutic problem – a growing diagnostic and therapeutic problem.

Abstract

In the ten last ten years in high-developed countries it was observed a distinct increase  in the incidence and severity of antibiotic associated diarrhea provoked caused by C. difficile (CDI).  It is associated for example with the appearance of new epidemic strain of C. difficile (BI/NAP1/BI/0O27) producing apart from the increased amount of toxins A and B, also a so-called binary toxin (ADP-ribosylotranspherase). Recurrent infections have been identified as a  special problem in CDI treatment because standard therapy failure rates are increasing. Risks of the CDI return belong to such factors as: lowered immunological response, previous CDI episode in the patients history, exhibition to other antibiotics, kidney failure, age >65 years, weakened immunological reply to toxins C. difficile, serious basic illness, long hospitalization, stay at the intensive station and infection with the NAP1/BI/027  strain. Existing methods of first line therapy of CDI (vancomycin, metronidazole) not only not always lead it to healing but they aren't also sheltering from recrudescence’s because they don’t eliminate spores of C. difficile. Works on new forms of therapy and CDI preventing last. Waking one of them up justified hopes is new macrocyclic antibiotic, fidaxsomycin, not absorbable from the digestive tract, fighting spores, selectively aimed at C. difficile and has good clinical results of very good conducted clinical trials, better results than vancomycin. At the work moreover a CDI prevention, their clinic, risk factors, principles of recognizing as well as available more and less experimental therapies for first and recurrent infections were presented.