Цель обзора

gastro-j

Российский журнал гастроэнтерологии, гепатологии, колопроктологии

Russian Journal of Gastroenterology, Hepatology, Coloproctology

1382-43762658-6673

«Gastro» LLC

gastro-j-1033

Research Article

ЛЕКЦИИ И ОБЗОРЫ

LECTURES AND REVIEWS

Clostridium difficile-ассоциированная болезнь

Clostridium difficile-associated disease

Ивашкин

В. Т.

Ivashkin

V. T.

Шифрин

О. С.

Shifrin

O. S.

Тертычный

А. С.

Tertycnhy

A. S.

Полуэктова

Е. А.

Poluektova

Ye. A.

Лапина

Т. Л.

Lapina

T. L.

Ляшенко

О. С.

Lyashenko

O. S.

Ивашкин

К. В.

Ivashkin

K. V.

ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава РФРоссияState educational government-financed institution of higher professional education «Sechenov First Moscow state medical university», Ministry of Healthcare of the Russian FederationRussian Federation

2015

30122015

256517

2015

Ивашкин В.Т., Шифрин О.С., Тертычный А.С., Полуэктова Е.А., Лапина Т.Л., Ляшенко О.С., Ивашкин К.В.

Ivashkin V.T., Shifrin O.S., Tertycnhy A.S., Poluektova Y.A., Lapina T.L., Lyashenko O.S., Ivashkin K.V.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.gastro-j.ru/jour/article/view/1033

Цель обзора

Цель обзора. Обобщить накопленные сведения об инфекции C. difficile, диагностике, лечению и профилактике C. difficile-ассоциированной болезни.

Основные положения

Основные положения. C. difficile — плохо растущая на питательных средах, облигатно-анаэробная, грамположительная, спорообразующая, цитотоксинпродуцирующая палочка. Токсины А и В C. difficile — белковые молекулы, относящиеся к гликозилтрансферазам. Воздействие токсинов вызывает повреждение кишечной стенки и воспаление в ней вследствие нарушения кишечного эпителиального барьера, индукции провоспалительных цитокинов, апоптоза и некроза эпителиоцитов. Основной клинический симптом C. difficile-ассоциированной болезни (в зависимости от степени ее тяжести) — диарея или диарея с кровью. Материал для обнаружения токсинов C. difficile — фекалии пациентов с диареей. В настоящее время предлагается несколько лабораторных методов для диагностики клостридиальной инфекции — исследование глутаматдегидрогеназы C. difficile, иммуноферментный анализ, полимеразная цепная реакция для токсигенного штамма C. difficile. Однако ответ на вопрос, какой из данных методов можно считать «золотым стандартом», пока не получен. Препататами для лечения больных служат метронидазол, ванкомицин, диоктаэдрический смектит, пробиотики. Для уменьшения риска развития клостридиальной инфекции рекомендовано рациональное назначение антибактериальных препаратов, сокращение по возможности сроков госпитализации, особенно у лиц старше 65 лет. В медицинских учреждениях должна проводиться предварительная, текущая и генеральная уборка, а также обработка рук медицинского персонала и медицинского инвентаря в соответствии с санитарно-эпидемиологическими правилами и нормативами.

Заключение

Заключение. С начала XXI века во многих странах мира отмечается стремительное нарастание случаев C. difficile-ассоциированной болезни. Рассматриваемая патология служит наиболее частой причиной внутрибольничной диареи, приводящей к значительному числу смертельных исходов. В этой связи представляется крайне важным уметь своевременно диагностировать, лечить данное заболевание и осуществлять его профилактику.

The aim of review

The aim of review. To generalize accumulated data on C. difficile infection, diagnostics, treatment and prevention of C.difficile-associated disease.

Summary

Summary. C.difficile is unthrifty on breeding grounds, obligate anaerobic, gram-positive, sporeforming, cytotoxin-producing bacterium. C. difficile toxins A and B are protein molecules, classified as glycosyltransferases. Influence of toxins induces damage and inflammation of intestinal wall due to impairment of intestinal epithelial barrier, stimulation of proinflammatory cytokine production, apoptosis and necrosis of epithelial cells. Basic clinical symptom of C. difficileassociated disease is diarrhea or diarrhea with hematochezia (according to severity of the case). Feces of patients with diarrhea are sampled for C. difficile toxin detection. Nowadays there are several laboratory diagnostic tests for Clostridial infection: testing for C. difficile glutamate dehydrogenase, enzyme-linked immunoassay, polymerase chain reaction for toxigenic strain of C. difficile. However, which of these methods may be considered to be «the gold standard» is unclear yet. Metronidazole, vancomycin, dioctaedric smectite and probiotics are used for treatment of C. difficile infection. Rational use of antibiotics, shortening of hospital stay terms whenever possible, especially for patients of 65 years of age and older is recommended to reduce the risk of clostridial infection development. Preliminary, routine and general cleaning should be carried out in medical institutions as well as the cleaning of hands of medical personnel and medical stock according to sanitary-and-epidemiologic rules and specifications.

Conclusion

Conclusion. From the beginning of XXI century in many countries of the world prompt increase of C. difficile-associated disease cases is marked. This disease is the most frequent cause of intrahospital diarrhea resulting in significant mortality. This is why it is extremely important to be able to diagnose, treat in due terms this disease and to carry out prophylactic procedures.

C. difficile-ассоциированная болезньпсевдомембранозный колиттоксины А и В C. difficileлечениеванкомицинметронидазолдиоктаэдрический смектитФлорасан Д

C. difficile-associated diseasepseudomembranous colitistoxins A and B of C. difficiletreatmentvancomycinmetronidazoledioctaedric smectiteflorasan D

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The authors declare that there are no conflicts of interest present.