Emerg Infect Dis

32620183PMC7454088826

Emerg Infect Dis

32818418PMC7454108826

Терапия и профилактика диареи, ассоциированной с инфекцией Clostridium difficile в период пандемии СOVID-19

КОРОНАВИРУСКОРОНАВИРУС ЧЕЛОВЕКАSARS-COV-2COVID-19КОМОРБИДНОСТЬСОПУТСТВУЮЩИЕ БОЛЕЗНИCLOSTRIDIUM DIFFICILEДИАРЕЯ /ДИАГН /ЛЕК ТЕР /ПРОФЭНТЕРОКОЛИТ ПСЕВДОМЕМБРАНОЗНЫЙКЛОСТРИДИОЗНЫЙ ЭНТЕРОКОЛИТКОЛИТ ПСЕВДОМЕМБРАНОЗНЫЙКОЛИТ, СВЯЗАННЫЙ С ПРИЕМОМ АНТИБИОТИКОВЭНТЕРИТ ПСЕВДОМЕМБРАНОЗНЫЙАНТИБИОТИК-АССОЦИИРОВАННАЯ ДИАРЕЯБИОЛОГИЧЕСКАЯ ТЕРАПИЯОБЗОР ЛИТЕРАТУРЫВ обзоре обобщены материалы международных клинических рекомендаций и результаты клинических испытаний по применению антибиотиков и биологической терапии для лечения и профилактики диареи, ассоциированной с инфекцией Clostridium difficile в условиях пандемии СOVID-19. Необходимым условием успешной терапии первого эпизода диареи, ассоциированной с инфекцией Clostridium difficile, является отмена ранее назначенных антибиотиков и своевременное назначение стандартной этиотропной терапии в течение 10 дней (ванкомицин, фидаксомицин или метронидазол в зависимости от тяжести случая). При повторных рецидивах псевдомембранозного колита показана стандартная терапия (ванкомицин, фидаксомицин) в конической/импульсной схеме до 5-8 недель с постепенным снижением дозы и кратности приема.The review summarizes the materials of international clinical guidelines and the results of clinical trials on the use of antibiotics and biological therapy for the treatment and prophylaxis of diarrhea associated with Clostridium difficile infection in the conditions of the COVID-19 pandemia. A requirement necessary for the successful treatment of the first episode of diarrhea associated with Clostridium difficile infection is the withdrawal of previously prescribed antibiotics and timely administration of the standard etiotropic therapy for 10 days (vancomycin, fidaxomicin, or metronidazole, depending on the severity of the case). In recurrent episodes of pseudomembranous colitis, the standard therapy (vancomycin, fidaxomicin) is provided in a tapered/pulsed regimen for up to 5-8 weeks with gradual reduction of the dose and frequency of administration

Therapy and prevention of diarrhea associated with Clostridium difficile infection during the COVID-19 pandemia

The review summarizes the materials of international clinical guidelines and the results of clinical trials on the use of antibiotics and biological therapy for the treatment and prophylaxis of diarrhea associated with Clostridium difficile infection in the conditions of the COVID-19 pandemia. A requirement necessary for the successful treatment of the first episode of diarrhea associated with Clostridium difficile infection is the withdrawal of previously prescribed antibiotics and timely administration of the standard etiotropic therapy for 10 days (vancomycin, fidaxomicin, or metronidazole, depending on the severity of the case). In recurrent episodes of pseudomembranous colitis, the standard therapy (vancomycin, fidaxomicin) is provided in a tapered/pulsed regimen for up to 5-8 weeks with gradual reduction of the dose and frequency of administration

A narrative synthesis on the epidemiology of Clostridioides difficile

Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Republica MoldovaIntroduction. Clostridium difficile has been identified as the leading cause of antibiotic therapy-associated diarrhea and colitis, which has evolved from sporadic complications of antimicrobial therapy to severe, sometimes fatal events that have eventually become an endemic life-threatening issue among hospitalized and immunosuppressed patients worldwide. Material and methods.The analysis of the relevant bibliographic sources retrieved from the PubMed, Google Scholar, and other platforms was carried out. All the articles related to these research objectives were selected, followed by exclusion of articles focused on clinics and diagnosis. The study included 43 content-based relevant articles. This present article reveals the evolving epidemiology of C. difficile infection (CDI). Results. Clostridium difficile is a sporulated bacterium responsible for infectious diarrhea and pseudomembranous colitis, showing high morbidity and mortality rates among patients, especially in high-risk groups. C. difficile mainly affects hospitalized people over 65 years old, who have been exposed earlier to antibiotics. The risk factors for C. difficile in these individuals include depletion of the protective intestinal flora by antibiotics and a low immune response to C. difficile due toboth the advanced age and medical comorbid-ities. The major outbreaks commonly occur in health care, as well as in long-term care institutions. However, CDI is not supervised in the Republic of Moldova. Conclusions. A system for reporting and monitoring ofC. difficile infection needs to be implemented in order to promptly and efficiently manage hospital outbreaks.Introducere.Clostridioides difficile este agentul cauzal principal al diareei și al colitei asociate cu antibioticoterapia, care a evoluat de la complicații sporadice ale terapiei antimicrobiene la evenimente severe, uneori letale, care au devenit o amenințare endemică atât pentru sănătatea pacienților spitalizați, cât și a celor imunosupresați la nivel mon-dial. Material și metode. A fost analizată sursa bibliografică existentă pe platforma PubMed și Google Scholar. Au fost selectate articole care au tangenţă cu obiectivele respectivei cercetări, iar după excluderea articolelor concentrate pe clinică şi diagnostic, în studiu au fost reflectate 43 de articole relevante temei propuse spre cercetare. În acest articol se tratează problema epidemiologiei în evoluție a infecției cu C. difficile (ICD). Rezultate. Clostridioides difficile este o bacterie sporulată, responsabilă de diareea infecțioasă și de colita pseudomembranoasă, cu o morbiditate și o mortalitate înaltă, în special la pacienții din grupul de risc. C. difficile afectează în special persoanele cu vârsta de peste 65 de ani, spitalizate, cu expunere recentă la antibiotice. Factorii de risc pentru infecția cu C. difficile îi constituie epuizarea florei intestinale protectoare la antibiotice și răspunsul imun diminuat din cauza vârstei și a comorbidităților medicale. De obicei, focarele importante apar în cadrul instituțiilor medico-sanitare, dar și a celor de îngrijire pe termen lung. Dar, e de menționat faptul că, la moment, ICD nu este supravegheată în R. Moldova. Concluzii. Un sistem de raportare și de supraveghere a infecției cu C. difficile este necesar a fi implementat, pentru a putea gestiona prompt și eficient focarele intraspitalicești

COVID19 pandemic is a «pandemic» of antimicrobial therapy

The article presents a critical analysis of antibiotic usage tactics in the treatment of patients with COVID-19 existing in Russian and foreign healthcare, and discusses the possible causes of unjustified antibiotic aggression in this category of patients. The potential negative consequences of the widespread use of antibiotics in patients carrying a new coronavirus infection are analyzed: life-threatening cardiotoxicity in patients with the simultaneous administration of such a "popular" candidate etiologic therapy as a combination of azithromycin and hydroxychloroquine, the potential development of other serious adverse drug reactions (in particular, the development of an antibiotic-associated pseudomembranous colitis, etc.), the expected dramatic increase in the secondary drug resistance of potentially pathogenic microorganisms to widely and often prescribed antibiotics