ABSTRACT
Clostridium difficile has become an important healthcare-associated infection due to increased frequency, mortality and recurrence rate. These facts, associated in part to the appearance of epidemic strains have driven changes in diagnostic and therapeutic approaches. The clinical spectrum of C. difficile infection (CDI) ranges from mild diarrhea without systemic compromise to life-threatening pseudomembranous colitis. Metronidazole is the first line treatment in mild CDI; however, the response rate is lower in severe disease, therefore in patients with clinical markers of unfavorable outcome, the first line treatment is oral vancomicin. On the other hand, the increased recurrence rate seen in the last decade with its clinical and economic consequences has forced the development of new therapies that allow change the course of this disease. In this line, the fecal microbiota transplantation and new antibiotics as fidaxomicin has proved to decrease the recurrences.
Clostridium difficile es actualmente una de las principales infecciones asociadas a la atención de salud debido al aumento de su frecuencia, letalidad y capacidad de recurrencia. Estos hechos en parte asociados al surgimiento de cepas conocidas como epidémicas han determinado grandes cambios en el enfrentamiento diagnóstico y terapéutico. El espectro clínico de la infección por C. difficile (ICD) abarca desde una diarrea leve sin compromiso sistémico hasta cuadros de colitis pseudomembranosa que pueden ocasionar la muerte. Metronidazol es el tratamiento de elección de la ICD leve; sin embargo, la tasa de respuesta es inferior en cuadros graves, por lo tanto, en pacientes con marcadores de mal pronóstico vancomicina oral es la terapia de primera elección. Por otro lado, la mayor tasa de recurrencia observada en la última década con sus consecuencias clínicas y económicas ha obligado al desarrollo de nuevas terapias que permitan alterar el curso de la enfermedad. En esta línea, el trasplante de microbiota fecal y nuevos antibióticos como fidaxomicina han mostrado efectividad en reducir las recurrencias.
Subject(s)
Humans , Clostridium Infections/complications , Clostridium Infections/therapy , Aminoglycosides/therapeutic use , Clostridioides difficile , Enterocolitis, Pseudomembranous/microbiology , Feces/microbiology , Recurrence , Vancomycin/therapeutic useABSTRACT
A infecção pelo Clostridium difficile é a principal causa de diarréia associada ao uso de antibióticos. Os pacientes com doença inflamatória intestinal apresentam um aumento na incidência e na gravidade da infecção, além de um maior tempo de hospitalização e maior taxa de mortalidade. Uma história prévia de colite parece ser o fator de risco mais importante para a aquisição da infecção. Apresentamos um caso de um paciente jovem, do sexo masculino, com ileíte de Crohn em uso de azatioprina e ciprofloxacino que evoluiu com colite nodular causada pelo Clostridium difficile.
Clostridium difficile infection is the leading cause of antibiotic associated diarrhea. Patients with inflamatory bowel are high incidence and have worse outcomes with higher rates of hospitalization, surgery, and mortality as compared to non-IBD CDI patients. Also they have increased rates of hospitalization, surgery, and mortality as a result of this infection. A prior history of colitis appears to be the most significant risk factor for acquiring this infection. We report a case of young man patient with ileitis Crohn disease in use of azathioprine and ciprofloxacin which has nodular colitis caused by Clostridium difficile.
Subject(s)
Humans , Male , Young Adult , Crohn Disease , Clostridioides difficile , Colitis , Diarrhea , Anti-Bacterial AgentsABSTRACT
La colitis asociada a antibióticos es una inflamación aguda de la mucosa intestinal que algunas veces ocurre a continuación del tratamiento con antibióticos y es causada por toxinas producidas por la bacteria Clostridium difficile. El diagnóstico está basado en el cuadro clínico y en cultivos y pruebas inmunológicas para detectar las toxinas. Cuando no hay respuesta al tratamiento conservador (retiro del antibiótico y terapia de apoyo), el Metronidazol o la Vancomicina deberían ser suministrados. Recurrencias hasta de un 20% son frecuentes. Medidas preventivas contra su extensión son esenciales, debido a la elevada transmisión a través del cuidado personal y de los instrumentos.
Antibiotic-associated colitis is an acute inflammation of the intestinal mucosa that sometimes occurs following antibiotic treatment and is caused by toxins produced by the bacterium Clostridium difficile. Diagnosis is based on culture and immunological tests to detect its toxins. When there is no response to conservative treatment (withdrawal of the antibiotic and support therapy), metronidazole or vancomycin should be given. Recurrences, up to 20%, are frequent. Preventive measures of its spreading are essential due to the elevated transmission through health care personnel and instruments.
ABSTRACT
There is resurgent interest in the use of probiotics to maintain gastrointestinal and systemic health, driven by recent advances in knowledge of bacterial interactions with the epithelium and innate immune system of the intestine. The effects of probiotic bacteria on the intestinal epithelium and their downstream consequences are reviewed. Probiotics prevent pathogen adherence and invasion of the epithelium, partly by blocking adherence sites but also by upregulating gene expression of MUC2 and of antimicrobial peptides. Metabolic effects of probiotics on the intestinal epithelium include production of short chain fatty acids which influence epithelial cell metabolism, turnover and apoptosis. Bacterial metabolism of unabsorbed dietary constituents with production of free radicals and phenolic metabolites can lead to DNA damage and cancer; probiotics restore eubiosis and potentially prevent this. Probiotics alter expression and redistribution of tight junction proteins and reduce intestinal permeability limiting absorption of noxious molecules from the gut lumen. Most studied are the effects of probiotics on epithelial cells which are the first line of innate immune-capable cells that encounter luminal flora. Probiotics, through secreted molecules, influence the innate inflammatory response of epithelial cells to stimuli from the gut lumen, and reduce mucosal inflammation. Through effects on dendritic, and possibly epithelial, cells they influence naïve T cells in the lamina propria of the gut and thus influence adaptive immunity. These varied effects of probiotics have implications for the treatment of several gastrointestinal diseases including antibiotic-associated colitis, acute gastroenteritis, inflammatory bowel disease, colon cancer, and irritable bowel syndrome.
ABSTRACT
OBJECTIVE:To analyze disease burden of antibiotic associated colitis(AAC)in patients with severe traumatic brain injury,and to explore prevention and treatment countermeasures. METHODS:Retrospective analysis method was used to analyze the relationship between the occurrence of AAC in 157 cases of severe traumatic brain injury and application duration,dosage and category of antibiotics. RESULTS:Overuse of antibiotics was closely associated with the occurrence of AAC,especially cephalosporins(P
ABSTRACT
Clinically, we often encounter patients who have symptoms of loose stool or diarrhea due to the use of antibiotics. Psuedomembranous colitis is the most frequent, but hemorrhagic colitis is rare. Penicillin-like-antibiotics-induced hemorrhagic colitis was infrequently reported in abroad, but in Korea, quinolone-induced colitis was reported. We found a case that the patient had the hematochezia after use of amoxicillin for eradication of H. pylori. Colonoscopic abnormalities showed superficial ulceration and mucosal edematous change without pseudomembrane on the ascending and transverse colon. We diagnosed the amoxicillin-induced hemorrhagic colitis by clinical course, colonoscopic findings, histologic findings and other laboratory results for differential diagnosis. This disease is rare but rapidly recovered after the withdrawal of the antibiotics and has a good prognosis. Therefore, we should differentiate this disease from hemorrhagic colitis of other causes by history taking.
Subject(s)
Humans , Amoxicillin , Anti-Bacterial Agents , Colitis , Colon, Transverse , Diagnosis, Differential , Diarrhea , Enterocolitis, Pseudomembranous , Gastrointestinal Hemorrhage , Korea , Prognosis , UlcerABSTRACT
Clinically, we often encounter patients who have symptoms of loose stool or diarrhea due to the use of antibiotics. Psuedomembranous colitis is the most frequent, but hemorrhagic colitis is rare. Penicillin-like-antibiotics-induced hemorrhagic colitis was infrequently reported in abroad, but in Korea, quinolone-induced colitis was reported. We found a case that the patient had the hematochezia after use of amoxicillin for eradication of H. pylori. Colonoscopic abnormalities showed superficial ulceration and mucosal edematous change without pseudomembrane on the ascending and transverse colon. We diagnosed the amoxicillin-induced hemorrhagic colitis by clinical course, colonoscopic findings, histologic findings and other laboratory results for differential diagnosis. This disease is rare but rapidly recovered after the withdrawal of the antibiotics and has a good prognosis. Therefore, we should differentiate this disease from hemorrhagic colitis of other causes by history taking.