Практические рекомендации Научного сообщества по содействию клиническому изучению микробиома человека, Российской гастроэнтерологической ассоциации и Российского общества по профилактике неинфекционных заболеваний по диагностике и лечению Clostridioides difficile (C. difficile)-ассоциированной болезни у взрослых

Цель исследования: в клинических рекомендациях, предназначенных для врачей-гастроэнтерологов, врачей-терапевтов, врачей-инфекционистов, врачей общей практики (семейных врачей), врачей-колопроктологов, врачей-хирургов и врачей-эндоскопистов, представлены современные методы диагностики, профилактики и лечения C. difficile-ассоциированной болезни.

Основное содержание. C. difficile-ассоциированная болезнь — заболевание, развивающееся при снижении разнообразия кишечной микробиоты и избыточной колонизации C. difficile, токсины которой вызывают повреждение слизисто-эпителиального барьера с последующим развитием воспаления в стенке толстой кишки, а характерным клиническим проявлением служит диарея. Клиническая картина заболевания может варьировать от бессимптомного носительства, легкой или умеренной диареи, купирующейся самостоятельно, до обильной водянистой диареи, псевдомембранозного колита с развитием жизнеугрожающих осложнений. Диагностика C. difficile-ассоциированной болезни основана на оценке клинической картины заболевания, данных анамнеза, объективного осмотра пациента и лабораторного обследования образцов кала. Тяжесть заболевания определяется клиническими симптомами и данными лабораторного обследования. К дополнительным диагностическим методам, выполняющимся по показаниям и способствующим оценке степени тяжести, относятся эндоскопическое исследование толстой кишки и методы визуализации брюшной полости. Лечение следует назначать в случаях характерной клинической картины C. difficile-ассоциированной болезни и положительных результатов лабораторного тестирования образцов стула. Выбор препарата и схем лечения зависит от степени тяжести эпизода, наличия осложнений и того, является ли эпизод первичным, рецидивом или реинфекцией.

Заключение. Определение целевых групп пациентов для диагностики клостридиальной инфекции имеет важное значение в предотвращении гипердиагностики и последующего необоснованного лечения. Своевременная диагностика и лечение C. difficile-ассоциированной болезни позволят избежать развития жизнеугрожающих осложнений и улучшить прогноз и качество жизни пациентов.

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