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Krankenhaushygiene up2date 2022; 17(03): 263-277
DOI: 10.1055/a-1396-3078
Infektiologie

Update Clostridioides-difficile-Infektion

Julia Koepsell
,
Simone Lieberknecht
,
Maria Vehreschild
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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.



Publication History

Article published online:
17 August 2022

© 2022. Thieme. All rights reserved.

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  • Literatur

  • 1 Aktories K, Schwan C, Jank T. Clostridium difficile Toxin Biology. Annual review of microbiology 2017; 71: 281-307 DOI: 10.1146/annurev-micro-090816-093458.
    CrossrefPubMedGoogle Scholar
  • 2 Kuijper EJ, Coignard B, Tüll P. Emergence of Clostridium difficile-associated disease in North America and Europe. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2006; 12 (Suppl. 06) 2-18 DOI: 10.1111/j.1469-0691.2006.01580.x.
    CrossrefPubMedGoogle Scholar
  • 3 Bundesministerium für Justiz. Gesetz zur Verhütung und Bekämpfung von Infektionskrankheiten beim Menschen (Infektionsschutzgesetz - IfSG), § 6 Meldepflichtige Krankheiten. Im Internet (Stand 23.03.2022): https://www.gesetze-im-internet.de/ifsg/__6.html
    Google Scholar
  • 4 Kuijper EJ, Coignard B, Brazier JS. et al. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro surveillance: bulletin Europeen sur les maladies transmissibles - European communicable disease bulletin 2007; 12: E1-2 DOI: 10.2807/esm.12.06.00714-en.
    CrossrefPubMedGoogle Scholar
  • 5 Pérez-Cobas AE, Moya A, Gosalbes MJ. et al. Colonization Resistance of the Gut Microbiota against Clostridium difficile. Antibiotics (Basel, Switzerland) 2015; 4: 337-357 DOI: 10.3390/antibiotics4030337.
    CrossrefPubMedGoogle Scholar
  • 6 Pérez-Cobas AE, Artacho A, Ott SJ. et al. Structural and functional changes in the gut microbiota associated to Clostridium difficile infection. Frontiers in microbiology 2014; 5: 335 DOI: 10.3389/fmicb.2014.00335.
    CrossrefPubMedGoogle Scholar
  • 7 Kellingray L, Gall GL, Defernez M. et al. Microbial taxonomic and metabolic alterations during faecal microbiota transplantation to treat Clostridium difficile infection. The Journal of infection 2018; 77: 107-118 DOI: 10.1016/j.jinf.2018.04.012.
    CrossrefPubMedGoogle Scholar
  • 8 Zhang F, Zuo T, Yeoh YK. et al. Longitudinal dynamics of gut bacteriome, mycobiome and virome after fecal microbiota transplantation in graft-versus-host disease. Nature communications 2021; 12: 65 DOI: 10.1038/s41467-020-20240-x.
    CrossrefPubMedGoogle Scholar
  • 9 Hensgens MP, Goorhuis A, Dekkers OM. et al. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. The Journal of antimicrobial chemotherapy 2012; 67: 742-748 DOI: 10.1093/jac/dkr508.
    CrossrefPubMedGoogle Scholar
  • 10 Theriot CM, Koenigsknecht MJ, Carlson Jr. PE. et al. Antibiotic-induced shifts in the mouse gut microbiome and metabolome increase susceptibility to Clostridium difficile infection. Nature communications 2014; 5: 3114 DOI: 10.1038/ncomms4114.
    CrossrefPubMedGoogle Scholar
  • 11 D'Silva KM, Mehta R, Mitchell M. et al. Proton pump inhibitor use and risk for recurrent Clostridioides difficile infection: a systematic review and meta-analysis. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2021; DOI: 10.1016/j.cmi.2021.01.008.
    CrossrefPubMedGoogle Scholar
  • 12 Spigaglia P. COVID-19 and Clostridioides difficile infection (CDI): Possible implications for elderly patients. Anaerobe 2020; 64: 102233 DOI: 10.1016/j.anaerobe.2020.102233.
    CrossrefPubMedGoogle Scholar
  • 13 Crobach MJ, Planche T, Eckert C. et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2016; 22 (Suppl. 04) S63-81 DOI: 10.1016/j.cmi.2016.03.010.
    CrossrefPubMedGoogle Scholar
  • 14 Johnson S, Lavergne V, Skinner AM. et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2021; 73: e1029-e1044 DOI: 10.1093/cid/ciab549.
    CrossrefPubMedGoogle Scholar
  • 15 Johnson S, Louie TJ, Gerding DN. et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2014; 59: 345-354 DOI: 10.1093/cid/ciu313.
    CrossrefPubMedGoogle Scholar
  • 16 Louie TJ, Miller MA, Mullane KM. et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. The New England journal of medicine 2011; 364: 422-431 DOI: 10.1056/NEJMoa0910812.
    CrossrefPubMedGoogle Scholar
  • 17 Cornely OA, Crook DW, Esposito R. et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. The Lancet Infectious diseases 2012; 12: 281-289 DOI: 10.1016/s1473-3099(11)70374-7.
    CrossrefPubMedGoogle Scholar
  • 18 Guery B, Menichetti F, Anttila VJ. et al. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial. The Lancet Infectious diseases 2018; 18: 296-307 DOI: 10.1016/s1473-3099(17)30751-x.
    CrossrefPubMedGoogle Scholar
  • 19 McDonald LC, Gerding DN, Johnson S. et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2018; 66: 987-994 DOI: 10.1093/cid/ciy149.
    CrossrefPubMedGoogle Scholar
  • 20 Lamontagne F, Labbé AC, Haeck O. et al. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Annals of surgery 2007; 245: 267-272 DOI: 10.1097/01.sla.0000236628.79550.e5.
    CrossrefPubMedGoogle Scholar
  • 21 Baunwall SMD, Lee MM, Eriksen MK. et al. Faecal microbiota transplantation for recurrent Clostridioides difficile infection: An updated systematic review and meta-analysis. EClinicalMedicine 2020; 100642: 29-30 DOI: 10.1016/j.eclinm.2020.100642.
    CrossrefPubMedGoogle Scholar
  • 22 Olsen MA, Yan Y, Reske KA. et al. Recurrent Clostridium difficile infection is associated with increased mortality. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2015; 21: 164-170 DOI: 10.1016/j.cmi.2014.08.017.
    CrossrefPubMedGoogle Scholar
  • 23 Kamboj M, Khosa P, Kaltsas A. et al. Relapse versus reinfection: surveillance of Clostridium difficile infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2011; 53: 1003-1006 DOI: 10.1093/cid/cir643.
    CrossrefPubMedGoogle Scholar
  • 24 Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2014; 20 (Suppl. 02) 1-26 DOI: 10.1111/1469-0691.12418.
    CrossrefPubMedGoogle Scholar
  • 25 van Nood E, Vrieze A, Nieuwdorp M. et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. The New England journal of medicine 2013; 368: 407-415 DOI: 10.1056/NEJMoa1205037.
    CrossrefPubMedGoogle Scholar
  • 26 Kelly CR, Yen EF, Grinspan AM. et al. Fecal Microbiota Transplantation Is Highly Effective in Real-World Practice: Initial Results From the FMT National Registry. Gastroenterology 2021; 160: 183-192.e183 DOI: 10.1053/j.gastro.2020.09.038.
    CrossrefPubMedGoogle Scholar
  • 27 Terveer EM, Vendrik KE, Ooijevaar RE. et al. Faecal microbiota transplantation for Clostridioides difficile infection: Four years’ experience of the Netherlands Donor Feces Bank. United European Gastroenterology Journal 2020; 8: 1236-1247 DOI: 10.1177/2050640620957765.
    CrossrefPubMedGoogle Scholar
  • 28 Ramai D, Zakhia K, Fields PJ. et al. Fecal Microbiota Transplantation (FMT) with Colonoscopy Is Superior to Enema and Nasogastric Tube While Comparable to Capsule for the Treatment of Recurrent Clostridioides difficile Infection: A Systematic Review and Meta-Analysis. Digestive diseases and sciences 2021; 66: 369-380 DOI: 10.1007/s10620-020-06185-7.
    CrossrefPubMedGoogle Scholar
  • 29 Leav BA, Blair B, Leney M. et al. Serum anti-toxin B antibody correlates with protection from recurrent Clostridium difficile infection (CDI). Vaccine 2010; 28: 965-969 DOI: 10.1016/j.vaccine.2009.10.144.
    CrossrefPubMedGoogle Scholar
  • 30 Gerding DN. Is pulsed dosing the answer to treatment of Clostridium difficile infection?. The Lancet Infectious diseases 2018; 18: 231-233 DOI: 10.1016/s1473-3099(17)30750-8.
    CrossrefPubMedGoogle Scholar
  • 31 Tschudin-Sutter S, Kuijper EJ, Durovic A. et al. Guidance document for prevention of Clostridium difficile infection in acute healthcare settings. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2018; 24: 1051-1054 DOI: 10.1016/j.cmi.2018.02.020.
    CrossrefPubMedGoogle Scholar
  • 32 Bentivegna E, Alessio G, Spuntarelli V. et al. Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection. American journal of infection control 2021; 49: 640-642 DOI: 10.1016/j.ajic.2020.09.010.
    CrossrefPubMedGoogle Scholar
  • 33 Baur D, Gladstone BP, Burkert F. et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. The Lancet Infectious diseases 2017; 17: 990-1001 DOI: 10.1016/s1473-3099(17)30325-0.
    CrossrefPubMedGoogle Scholar
  • 34 Krutova M, Kinross P, Barbut F. et al. How to: Surveillance of Clostridium difficile infections. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2018; 24: 469-475 DOI: 10.1016/j.cmi.2017.12.008.
    CrossrefPubMedGoogle Scholar
  • 35 Johnson SW, Brown SV, Priest DH. Effectiveness of Oral Vancomycin for Prevention of Healthcare Facility-Onset Clostridioides difficile Infection in Targeted Patients During Systemic Antibiotic Exposure. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2020; 71: 1133-1139 DOI: 10.1093/cid/ciz966.
    CrossrefPubMedGoogle Scholar
  • 36 de Bruyn G, Gordon DL, Steiner T. et al. Safety, immunogenicity, and efficacy of a Clostridioides difficile toxoid vaccine candidate: a phase 3 multicentre, observer-blind, randomised, controlled trial. The Lancet Infectious diseases 2021; 21: 252-262 DOI: 10.1016/s1473-3099(20)30331-5.
    CrossrefPubMedGoogle Scholar
  • 37 Goldenberg JZ, Yap C, Lytvyn L. et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. The Cochrane database of systematic reviews 2017; 12: Cd006095 DOI: 10.1002/14651858.CD006095.pub4.
    CrossrefPubMedGoogle Scholar
  • 38 Shen NT, Maw A, Tmanova LL. et al. Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis. Gastroenterology 2017; 152: 1889-1900.e1889 DOI: 10.1053/j.gastro.2017.02.003.
    CrossrefPubMedGoogle Scholar
  • 39 Hempel S, Newberry SJ, Maher AR. et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. Jama 2012; 307: 1959-1969 DOI: 10.1001/jama.2012.3507.
    CrossrefPubMedGoogle Scholar