Современные подходы к диагностике и лечению Clostridioides difficile (C. difficile)-ассоциированной болезни у взрослых (Обзор литературы и резолюция Экспертного совета)

Цель публикации. Рассмотреть современные подходы к диагностике и лечению C. difficile-ассоциированной болезни у взрослых и представить материалы Экспертного совета, который состоялся 25 марта 2023 г. в Москве.

Основные положения. C. difficile является наиболее значимой нозокомиальной инфекцией, споры которой также широко представлены в окружающей среде. Нарушение состава микробиоты, в первую очередь при приеме антибактериальных препаратов, является ключевым этапом в развитии C. difficile-ассоциированной болезни. Диагностика инфекции должна проводиться только у пациентов с диареей, при этом целесообразно использовать не менее двух лабораторных методов. Препаратом выбора для первой линии лечения служит ванкомицин. В случае неэффективности консервативного лечения, а также у пациентов с рецидивирующей клостридиальной инфекцией целесообразно рассмотреть вопрос о проведении трансплантации фекальной микробиоты. Пробиотический штамм Saccharomyces boulardii CNCM I-745 оказывает прямое ингибирующее действие на токсин А C. difficile, способствует нормализации состава кишечной микробиоты, а также уменьшению воспалительной реакции в слизистой оболочке толстой кишки при колонизации токсигенным штаммом C. difficile.

Выводы. Добавление пробиотического штамма Saccharomyces boulardii CNCM I-745 на фоне антибактериальной терапии способствует как первичной, так и вторичной профилактике C. difficile-ассоциированной болезни.

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