The effect of Clostridium difficile infection on the course of liver cirrhosis

Aim of investigation. To estimate the frequency of Clostridium difficile (C. difficile) infection and its effect on severity and pattern of complications at the compensated liver cirrhosis (LC). Material and methods. The original study included overall 47 patients with decompensated LC (Child-Pugh class B - 27 patients and class C - 20 patients). All patients underwent clinical interviewing with assessment of past history, daily blood pressure (BP) measurement with calculation of the mean blood pressure level, blood tests, ECG, abdominal ultrasound, esophagogastroduodenoscopy, echocardiography, chest X-ray, lactulose hydrogen breath test, Clostridium difficile ELISA stool test. Results. Clostridium difficile infection was found in 26 (55.3%) of 47 patients with decompensated LC. Of patients with alcoholic LC the mean Maddrey score in Clostridium difficile-infected subgroup was significantly higher than the score of non-infected patients. For the last 6 months prior to the study enrollment 50% of patients with Clostridium difficile infection were hospitalized and received antibiotics significantly more frequently. Metronidazole was prescribed more frequently to Clostridium difficile-infected patients (92.3% versus 9.5%; р<0.001), 69.2% of infected patients received proton pump inhibitors vs 85.7% of non-infected patients (p=0.3). According to laboratory test results the trend to increase of fibrinogen level and microhematuria severity at clostridial infection was found. At abdominal ultrasound significant difference in craniocaudal dimension of the left liver lobe between the studied groups of patients (p=0.026) was found. Conclusions. Study results indicate high frequency of C. difficile infection at decompensated liver cirrhosis (55.3%), but it is symptomless in most of the cases (in 95.7% of patients). The causes for such course of disease is poorly understood. Clostridial infection increases severity of the patient state with the alcoholic liver disease as confirmed by higher Maddrey score. C. difficile infection develops much more frequently in patients who previously received metronidazole treatment for the last 6 months. In spite of the fact, that metronidazole is one of drugs of choice at C. difficile eradication, obtained results indicate the possible interrelation of metronidazole treatment to clostridial infection that was previously described in the literature.

цирроз печени, клостридиальная инфекция, метронидазол

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