Diarreia causada por clostridium difficile: recentes avanços / Diarrhea caused by clostridium difficile: recent Advances

A infecção causada por Clostridium difficile (C. difficile), um dos agentes causadores de diarréia aguda e recorrente, tem como principal fator de risco o uso de antimicrobianos. Recentemente, houve um aumento da incidência e da mortalidade desta afecção. Clinicamente, a mesma pode manifestar-se desde um quadro de diarreia aquosa leve até a forma grave de colite pseudomembranosa. O objetivo deste artigo é apontar as mudanças epidemiológicas da infecção pelo C. difficile, além de rever fatores de risco, manifestações clínicas, métodos diagnósticos, tratamento e prevenção desta infecção. O aumento na gravidade da infecção causada pelo C. difficile é relacionado a uma nova cepa hipervirulenta, BI/NAPI/Ribotipo 027, que apresenta maior capacidade de produção de toxinas. Essa nova cepa, mais virulenta, ainda não foi detectada no Brasil, porém como já foi identificada em outros países da América, alerta para a preocupante capacidade de disseminação universal. Essa revisão é baseada em artigos publicados nos últimos 10 anos, utilizando como base de dados o PubMed e o Scielo (Scientific Eletronic Library Online), com as palavras-chave: Epidemiologia, diarreia, Clostridium difficile e cepa hipervirulenta.

Clostridium difficile (C. difficile) is a causative agent of diarrhea and its main risk factor is the use of antimicrobials. Recently, there was an increase in incidence and mortality. Clinical symptoms can manifest from mild watery diarrhea to severe pseudomembranous colitis. The purpose of this article is to make a literature review of C. difficile -associated diarrhea including its recent epidemiological changes. The increase in the severity of infection caused by Clostridium difficile was related to a new hypervirulent strain, BI/NAPI/ribotype 027, with greater capacity for production of toxins, responsible for clinical manifestations. This new strain, more virulent, has not yet been detected in Brazil, but it was already identified in other countries of America, warns the disturbing ability to universal dissemination. This review is based on articles published in the last 10 years, using as database PubMed and Scielo (Scientific Electronic Library Online), with the keywords: Epidemiology, diarrhea, Clostridium difficile and hypervirulent strain.

Fidaxomicin - the new drug for Clostridium difficile infection.

Clostridium difficile is one of the many aetiological agents of antibiotic associated diarrhoea and is implicated in 15-25 per cent of the cases. The organism is also involved in the exacearbation of inflammatory bowel disease and extracolonic manifestations. Due to increase in the incidence of C. difficile infection (CDI), emergence of hypervirulent strains, and increased frequency of recurrence, the clinical management of the disease has become important. The management of CDI is based on disease severity, and current antibiotic treatment options are limited to vancomycin or metronidazole in the developing countries. this review article briefly describes important aspects of CDI, and the new drug, fidaxomicin, for its treatment. Fidaxomicin is particularly active against C.difficile and acts by inhibition of RNA synthesis. Clinical trials done to compare the efficacy and safety of fidaxomicin with that of vancomycin in treating CDI concluded that fidaxomicin was non-inferior to vancomycin for treatment of CDI and that there was a significant reduction in recurrences. The bactericidal properties of fidaxomicin make it an ideal alternative for CDI treatment. However, fidaxomicin use should be considered taking into account the potential benefits of the drug, along with the medical requirements of the patient, the risks of treatment and the high cost of fidaxomicin compared to other treatment regimens.