Clostridioides Difficile Infection PDF

Denumirea cartii | 1 4.1.4. Clostridioides (Clostridium) difficile infection Clostridioides difficile (CDI) infection (formerly known as Clostridium) is an important global public health problem, particularly in light of its share in healthcare-associated infections (HAI). Etiology...

Denumirea cartii | 1 4.1.4. Clostridioides (Clostridium) difficile infection Clostridioides difficile (CDI) infection (formerly known as Clostridium) is an important global public health problem, particularly in light of its share in healthcare-associated infections (HAI). Etiology. C. difficile - anaerobic, gram-positive, sporulated, toxin- producing bacillus. 027 ribotype is associated with HAI, resistance to antibiotics (fluoroquinolones), higher severity and mortality, and higher rate of complications and recurrences. Epidemiology. Nosocomial or institutionalized infections are most often described, although community-acquired C difficile infections are also reported. It can colonize the digestive tract (5-15% of adults), with patients remaining asymptomatic until a risk factor overlaps (eg antibiotic therapy). The colonization rate can be as high as 20% among patients hospitalized for more than 1 week and 1-3% in the community. Colonization of the digestive tract in children under 2 years of age has no clinical significance. Source of infection: patients and asymptomatic carriers. Transmission is carried out through the fecal-oral route, either through direct contact with the faecal matter of another patient or indirectly, through contaminated objects, including medical instruments, bed linen, the hands of medical personnel, etc. Spores, the resistance form of the microorganism, can persist on surfaces for a long time (5 months). Risk factors include age over 65 years, immunosuppressive diseases or treatments, chemotherapy, malignancies, recent digestive surgery, inflammatory gastrointestinal diseases, prolonged hospitalization (especially in ICU units), use of gastric antisecretory agents and antibiotic therapy, especially broad-spectrum, in prolonged cures. The most frequently incriminated classes of high-risk antibiotics include fluoroquinolones, II-V generation cephalosporins, carbapenems, clindamycin, but C. difficile infection can also be associated with the use of other antibiotics, manifesting clinically at a time interval between the second day after the initiation of antibiotic therapy and 6 weeks after its termination. Pathogenesis. Spore ingestion leads to intestinal colonization with C difficile, which may remain asymptomatic until a risk factor overlaps. Alteration of the saprophytic intestinal flora (dysbiosis), associated with 2 | Denumirea cartii sau a sectiunii/capitolului antibiotic therapy or other risk factors, causes the germination of spores in vegetative forms, which produce toxins A (enterotoxin), with a role in the secretion of fluid in the intestinal lumen, and B (cytotoxin), with a cytopathic effect. 027 ribotypeis is more frequently associated with the production of the binary toxin (actin-specific DNA-ribosyltransferase), which sums up the effects of A and B toxins. Toxins bind through specific receptors on the surface of enterocytes and are transported intracellularly. An important inflammatory process occurs, with the attraction of polymorphonuclear cells to the level of the intestinal lamina propria, the destruction of enterocytes and the appearance of endoscopically visible pseudomembranes. The clinical picture is dominated by the emission of diarrheal stools, at least 3/day, of low consistency, sometimes with pathological elements (mucus, blood), which can be associated with fever, vomiting, abdominal pain and signs of dehydration. In severe forms, arterial hypotension, shock, abdominal distention occur. Clinical forms include mild/moderate diarrhea associated with antibiotic therapy, pseudomembranous colitis and fulminant colitis associated with severe complications: ileus, toxic megacolon, septic shock and high mortality. Tabel 1. ATLAS score Criteria 0 points 1 point 2 points (Age) - years < 60 years 60-79 years >80 years Temperature (°C) < 37,5 37,6-38,5 >38,6 Leukocytes /mm3 < 16000 16-25000 >25000 Serum albumin (g/dL) >3,5 2,6-3,5