Этиологическая структура антибиотико-ассоциированной диареи у пациентов с заболеваниями толстой кишки

Abstract

Aim. Determine the etiological structure of antibiotic-associated diarrhea in Russia. Materials and methods. The study included 746 patients in inpatient treatment. 502 patients were examined at the stage of admission and discharge from the hospital, and 305 patients with the clinical picture of Clostridioides difficile-associated infection (CDI), among them 163 (46.6%) men and 142 (53.4%) women. The age of the patients was 48-67 years. All patients were examined luminal feces upon admission to the hospital, upon discharge from the hospital and in the case of a clinical picture of CDI. Results. Analysis of the etiological factor of clostridial infection showed that in 253 (83.2%) cases, the causative agent of antibiotic-associated diarrhea was C. difficile. Other types of clostridia were found in almost all CDI cases (97.7%). At the same time, C. perfringens remained the dominant type of clostridia in the same way as in patients upon admission to the clinic. The average dissemination of C. difficile was higher (p <0.05) compared with the value of the indicator in patients on admission and was 10 * 7 CFU / g; the titer of dissemination with other types of clostridia remained at the level of 10 * 5 CFU / g. - 10 * 7 CFU / g., Median 10 * 6 CFU / g. Analysis of the clinical picture of clostridial colitis revealed its similarity, regardless of the etiologically significant microorganism being detected. In 52 (16.8%) of 305 patients, the clinical picture was due to other members of the genus Clostridium (Clostridium perfringens, C. paraputrificum, C. tertium, C. novyi). Also, as with CDI, diarrhea syndrome occurred in 100% of cases, hyperthermia occurred in 82%, flatulence in 42%, vomiting in 13%, and abdominal pain in 11%. The severity of Clostridium spp. Diarrhea varied widely. So, in 26 (50%) of 52 patients with preserved anal defecation, the median stool frequency was 10 (5; 14) times / day, which is comparable with the data obtained in colitis caused by C. difficile. Conclusions. An analysis of the etiological factor in the development of CDI showed that, in addition to the known etiological factor of antibiotic-associated diarrhea - toxigenic C. difficile with the leading virulence factor production of toxin B, in 52 (16.9%) cases, other representatives of this genus were an etiological factor of diarrhea (Clostridium perfringens, C. paraputrificum, C. tertium, C. novyi). The development of antibiotic-associated diarrhea, caused by representatives of other types of clostridia, must be considered when prescribing therapy for clostridial colitis.