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Clostridium difficile auf der Intensivstation

Clostridium difficile in the intensive care unit

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Zusammenfassung

Auf der Intensivstation ist die Clostridienenteritis mit einer Prävalenz von 1–2 % der Patienten eine nicht seltene Erkrankung, die den Behandler vor besondere Herausforderungen stellt. Für Europa liegen nur wenige belastbare Daten bezüglich Schweregrad und Therapie der Clostridium difficile Infektionen (CDI) bei Intensivpatienten vor; die Übertragbarkeit von Ergebnissen aus Studien mit anderen Patientenkollektiven ist teilweise problematisch. Auch die Empfehlungen zu Diagnostik und Therapie sind auf diese Patienten aufgrund der meist ausgeprägten Komorbiditäten oft nur mit Einschränkungen anwendbar. Zudem zeigt sich in letzter Zeit immer deutlicher, dass bei einem mit 10–20 % relevanten Teil aller Patienten eine asymptomatische Kolonisation mit C. difficile besteht, die in ihrer Relevanz für den Patienten und für die Übertragung im Krankenhaus bislang nicht gut verstanden ist. Unter Berücksichtigung der aktuellen Literatur geben wir einen Überblick über aktuelle Herausforderungen in Diagnostik und Verlaufsabschätzung, primäre Behandlungsoptionen sowie Behandlungsalternativen bei besonderen Problemen und Therapieversagen. Zudem gehen wir auf die Prävention von Neuerkrankungen auf der Intensivstation ein.

Abstract

Clostridium difficile infections (CDI) are encountered in about 1–2% of patients in the intensive care unit (ICU) and pose a special challenge to those who provide care. Only little data regarding severity and management of CDI in ICU patients in Europe are available. Extrapolation of results from one patient population to another is often difficult. The comorbidities of those patients often limit the application of general recommendations concerning diagnosis and therapy. In addition, there are a relevant percentage of patients (10–20%) with asymptomatic C. difficile colonization. The relevance for the patient and for the risk of patient to patient infection is not yet fully understood. Based on available data, we give an overview of current challenges in the diagnosis, assessment of disease course, primary management options, and alternatives in special cases and treatment failures of CDI. We also discuss prevention of new CDI in the intensive care unit.

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Literatur

  1. Baur D, Gladstone BP, Burkert F et al (2017) Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 17(9):990–1001

    Article  Google Scholar 

  2. Bouza E, Rodríguez-Créixems M, Alcalá L et al (2015) Is clostridium difficile infection an increasingly common severe disease in adult intensive care units? A 10-year experience. J Crit Care 30(3):543–549

    Article  CAS  Google Scholar 

  3. Britt NS, Steed ME, Potter EM et al (2014) Tigecycline for the treatment of severe and severe complicated clostridium difficile infection. Infect Dis Ther 3(2):321–331

    Article  Google Scholar 

  4. Bruensing J, Matthes M, Dückers H et al (2014) Administration of proton pump inhibitors in critically ill medical patients is associated with increased risk of developing Clostridium difficile-associated diarrhea. J Crit Care 29(4):696.e11–696.e15

    Article  Google Scholar 

  5. Bruensing J, buendgens L, Jochum C et al (2018) Diagnostik und Therapie von Clostridium difficile Infektionen auf deutschen Intensivstationen – eine Umfrage unter Intensivmedizinern. Z Gastroenterol 56(06):551–560. https://doi.org/10.1055/s-0044-102103

    Article  PubMed  Google Scholar 

  6. Burkart NE, Kwaan MR, Shepela C et al (2011) Indications and relative utility of lower endoscopy in the management of clostridium difficile infection. Gastroenterol Res Pract. https://doi.org/10.1155/2011/626582

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cadnum JLB, Jencson ALC, O’Donnell MCC et al (2017) An increase in healthcare–associated clostridium difficile infection associated with use of a defective peracetic acid-based surface disinfectant. Infect Control Hosp Epidemiol 38(3):300–305

    Article  Google Scholar 

  8. Carignan A, Poulin S, Martin P et al (2016) Efficacy of secondary prophylaxis with vancomycin for preventing recurrent clostridium difficile infections. Am J Gastroenterol 111(12):1834–1840

    Article  CAS  Google Scholar 

  9. Crook DW, Walker AS, Kean Y et al (2012) Fidaxomicin versus vancomycin for clostridium difficile infection: meta-analysis of pivotal randomized controlled trials. Clin Infect Dis 55(Suppl 2):103

    Google Scholar 

  10. Cruz-Betancourt A, Cooper CD, Sposato K et al (2016) Effects of a predictive preventive model for prevention of clostridium difficile infection in patients in intensive care units. Am J Infect Control 44(4):421–424

    Article  Google Scholar 

  11. Davido B, Batista R, Michelon H et al (2017) Is faecal microbiota transplantation an option to eradicate highly drug-resistant enteric bacteria carriage? J Hosp Infect 95(4):433–437

    Article  CAS  Google Scholar 

  12. Debast SB, Bauer MP, Kuijper EJ (2014) European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for clostridium difficile infection. Clin Microbiol Infect 20(Suppl 2):1–26

    Article  CAS  Google Scholar 

  13. Faleck DM, Salmasian H, Furuya EY et al (2016) Proton pump inhibitors do not increase risk for clostridium difficile infection in the intensive care unit. Am J Gastroenterol 111(11):1641–1648

    Article  CAS  Google Scholar 

  14. Fischer M, Sipe BW, Rogers NA et al (2015) Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated clostridium difficile infection: description of a protocol with high success rate. Aliment Pharmacol Ther 42(4):470–476

    Article  CAS  Google Scholar 

  15. Furuya-Kanamori L, Clements AC, Foster NF et al (2017) Asymptomatic clostridium difficile colonization in two Australian tertiary hospitals, 2012-2014: prospective, repeated cross-sectional study. Clin Microbiol Infect 23(1):48.e1–48.e7

    Article  CAS  Google Scholar 

  16. Gergely Szabo B, Kadar B, Szidonia Lenart K et al (2016) Use of intravenous tigecycline in patients with severe clostridium difficile infection: a retrospective observational cohort study. Clin Microbiol Infect 22(12):990–995

    Article  CAS  Google Scholar 

  17. Gleich S, Schaffer A, Mai CH et al (2017) Clostridium-difficile-assoziierte Todesfalle 2013–2016 in Munchen und Nurnberg. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 60(10):1067–1074

    Article  Google Scholar 

  18. Godfrey MS, Finn A, Zainah H et al (2015) Metronidazole-induced encephalopathy after prolonged metronidazole course for treatment of C. difficile colitis. BMJ Case Rep. https://doi.org/10.1136/bcr-2014-206162

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hagel S, Epple H‑J, Feurle GE et al (2015) S2k-guideline gastrointestinal infectious diseases and Whipple’s disease. Z Gastroenterol 53(5):418–459

    Article  CAS  Google Scholar 

  20. Johnson S, Louie TJ, Gerding DN et al (2014) Vancomycin, metronidazole, or tolevamer for clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis 59(3):345–354

    Article  CAS  Google Scholar 

  21. Juang P, Skledar SJ, Zgheib NK et al (2007) Clinical outcomes of intravenous immune globulin in severe clostridium difficile-associated diarrhea. Am J Infect Control 35(2):131–137

    Article  Google Scholar 

  22. Julien M, Wild JL, Blansfield J et al (2016) Severe complicated clostridium difficile infection: can the UPMC proposed scoring system predict the need for surgery? J Trauma Acute Care Surg 81(2):221–228

    Article  Google Scholar 

  23. Kachrimanidou M, Tegou Z, Chasampalioti M et al (2017) A two-step approach improves the diagnosis of clostridium difficile infection. J Microbiol Methods 143:17–19

    Article  CAS  Google Scholar 

  24. Karanika S, Paudel S, Zervou FN et al (2016) Prevalence and clinical outcomes of clostridium difficile infection in the intensive care unit: a systematic review and meta-analysis. Open Forum Infect Dis 3(1):ofv186

    Article  Google Scholar 

  25. Khanafer N, Barbut F, Eckert C et al (2016) Factors predictive of severe clostridium difficile infection depend on the definition used. Anaerobe 37:43–48

    Article  Google Scholar 

  26. Kim PK, Huh HC, Cohen HW et al (2013) Intracolonic vancomycin for severe clostridium difficile colitis. Surg Infect (Larchmt) 14(6):532–539

    Article  Google Scholar 

  27. Kulaylat AS, Kassam Z, Hollenbeak CS et al (2017) A surgical clostridium-associated risk of death score predicts mortality after colectomy for clostridium difficile. Dis Colon Rectum 60(12):1285–1290

    Article  Google Scholar 

  28. Ma SSY, Saxton JD, Martzen MR et al (2013) Probiotics for the prevention of clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006095.pub3

    Article  PubMed  Google Scholar 

  29. Meybeck A, Gois J, Devos P et al (2014) Clostridium difficile colitis acquired in the intensive care unit: outcome and prognostic factors. Infection 42(1):23–30

    Article  Google Scholar 

  30. Pham VP, Luce AM, Ruppelt SC et al (2015) Age-stratified treatment response rates in hospitalized patients with clostridium difficile infection treated with metronidazole. Antimicrob Agents Chemother 59(10):6113–6116

    Article  CAS  Google Scholar 

  31. Planche T, Aghaizu A, Holliman R et al (2008) Diagnosis of clostridium difficile infection by toxin detection kits: a systematic review. Lancet Infect Dis 8(12):777–784

    Article  Google Scholar 

  32. Planche T, Eckert C, Barbut F et al (2016) European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for clostridium difficile infection. Clin Microbiol Infect 22(Suppl 4):S63–S81

    PubMed  Google Scholar 

  33. Polage CR, Gyorke CE, Kennedy MA et al (2015) Overdiagnosis of clostridium difficile infection in the molecular test era. JAMA Intern Med 175(11):1792

    Article  Google Scholar 

  34. Popovic N, Korac M, Nesic Z et al (2015) Oral teicoplanin for successful treatment of severe refractory clostridium difficile infection. Eur J Clin Microbiol Infect Dis 37:745. https://doi.org/10.1007/s10096-017-3169-3

    Article  CAS  Google Scholar 

  35. Press A, Ku B, McCullagh L et al (2016) Developing a clinical prediction rule for first hospital-onset clostridium difficile infections: a retrospective observational study. Infect Control Hosp Epidemiol 37(5):896–900. https://doi.org/10.1017/ice.2016.97

    Article  PubMed  Google Scholar 

  36. Robert Koch-Institut (2017) Infektionsepidemiologisches Jahrbuch für 2016. RKI, Berlin

    Book  Google Scholar 

  37. Sabbah MA, Schorr C, Czosnowski QA et al (2015) Risk of clostridium difficile infection in intensive care unit patients with sepsis exposed to metronidazole. Infect Dis (Lond) 47(4):197–202

    Article  CAS  Google Scholar 

  38. Salzberger B, Rauscher C (2015) Das Mikrobiom des Darms beim kritisch kranken Patienten. Med Klin Intensivmed Notfmed 110(7):521–525

    Article  CAS  Google Scholar 

  39. Shrestha SK, Sunkesula VC, Kundrapu S et al (2016) Acquisition of clostridium difficile on hands of healthcare personnel caring for patients with resolved C. difficile infection. Infect Control Hosp Epidemiol 37(04):475–477

    Article  Google Scholar 

  40. Stevens VW, Nelson RE, Schwab-Daugherty EM et al (2017) Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with clostridium difficile infection. JAMA Intern Med 177(4):546–553

    Article  Google Scholar 

  41. Surawicz CM, Brandt LJ, Binion DG et al (2013) Guidelines for diagnosis, treatment, and prevention of clostridium difficile infections. Am J Gastroenterol 108(4):478–498

    Article  CAS  Google Scholar 

  42. Trifan A, Stanciu C, Girleanu I et al (2017) Proton pump inhibitors therapy and risk of clostridium difficile infection: systematic review and meta-analysis. World J Gastroenterol 23(35):6500–6515

    Article  CAS  Google Scholar 

  43. Wilcox MH, Gerding DN, Poxton IR et al (2017) Bezlotoxumab for prevention of recurrent clostridium difficile infection. N Engl J Med 376(4):305–317

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie), Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland

    F. Prechter & A. Stallmach

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Correspondence to F. Prechter.

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F. Prechter gibt an, dass kein Interessenkonflikt besteht. A. Stallmach erhielt Honorare von Astellas, MSD, Summit Therapeutics.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Buerke, Siegen

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Prechter, F., Stallmach, A. Clostridium difficile auf der Intensivstation. Med Klin Intensivmed Notfmed 115, 81–87 (2020). https://doi.org/10.1007/s00063-018-0459-1

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