Das Darmbakterium Clostridioides difficile ist eine der häufigsten Ursachen nosokomialer Diarrhöen. Die C.-difficile-Infektion (CDI) ist mit einer hohen Morbidität und Mortalität assoziiert und hat daher eine große klinische, epidemiologische und auch ökonomische Bedeutung. Eine frühzeitige Diagnosestellung sowie evidenzbasierte Therapie- und Hygienemaßnahmen spielen eine entscheidende Rolle für das Management der CDI.
Kernaussagen
Metronidazol wird nicht mehr als Antibiotikum der Wahl bei einer nicht-schweren CDI empfohlen.
Fidaxomicin wird aufgrund einer ähnlichen primären Heilungsrate wie Vancomycin, jedoch niedrigeren Rezidivraten und geringeren Auswirkungen auf die Mikrobiota als Therapie der Wahl einer initialen wie auch rezidivierenden CDI-Episode empfohlen. Aufgrund der hohen Therapiekosten lässt sich diese Empfehlung aber nicht immer umsetzen. Unser Ansatz in diesem Spannungsfeld ist die Priorisierung des Einsatzes in Hochrisikogruppen für ein Rezidiv, z. B. in der Hämato-Onkologie.
Die intestinale Mikrobiota spielt eine wichtige Rolle in der Pathogenese der CDI, weshalb der fäkale Mikrobiotatransfer spätestens ab dem 2. Rezidiv zur Sekundärprophylaxe im symptomfreien Intervall diskutiert werden sollte.
Ab dem 1. Rezidiv kann man zur Sekundärprophylaxe die Gabe des monoklonalen Antikörpers Bezlotoxumab diskutieren. Bei besonders gefährdeten Patientengruppen sollte eine Gabe bereits in der initialen Episode erwogen werden.
Im klinischen Alltag sollten neben Hygienemaßnahmen ein Antibiotic-Stewardship-Programm und ein Surveillance-System für CDIs etabliert werden.
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