Соеви на Clostridium difficile асоцирани со нозокомијални инфекции – лабораториска дијагноза, преваленца, осетливост и молекуларна карактеризација на изолатите

Kiril Mihajlov, Elena Trajkovska Dokic

Извадок


Иако во минатото не и се придаваше големо значење на оваа бактерија, денес Clostridium difficile е еден од најзначајните агенси кои се поврзуваат со инфекции стекнати во болничката средина. Главната причина за ова е големата отпорност на Clostridium difficile како кон антибиотици, така и кон други надворешни влијанија како резултат на способноста за спорулација и секако способноста за лачење на токсини. Во Република Македонија нема податоци за преваленцата на инфекциите со оваа бактерија, ниту е одредена осетливоста и молекуларната карактеризација на изолираните соеви.

Анализирајќи 65 рецензирани трудови од оваа проблематика, најдени со пребарување низ базата на податоци од „Пабмед централ“ добиваме интересни сознанија за изолираните соеви на Clostridium difficile низ светот, најчесто од хоспитализирани пациенти со антибиотик асоцирана дијареа.

Во однос на дијагнозата се препорачува триделниот алгоритам (директен скрининг на глутамат дехидрогеназа-ГДХ, плус фекална детекција на токсините А и В и токсикогена култура) како мошне ефикасен начин за детекција на овие инфекции. Со него би се опфатиле многу случаи кои би биле пропуштени со другите алгоритми. Можноста од детекција на повеќе случаи го намалува бројот на случаи по пат на трансмисија во болниците, а со тоа и вкупните трошоци како резултат на пролонгирана хоспитализација.

Стандардна терапија за инфекции со C. difficilе е орално метронидазол или ванкомицин. Пациентите со тешки и рефракторни инфекции со C. difficilе успешно се третираат интравенски со тигециклин. Тигециклин има најниски вредности за MИК90 за C. difficile, а понатаму следат даптомицин, метронидазол и ванкомицин (1 μg/ml). Клиндамицинот покажал највисоки МИК вредности од сите тестирани антимикробни агенси. Употребата на клиндамицин е поврзана со висок ризик за индуцирање на инфекција со C. difficilе.

Во поголемиот број студии, сите соеви биле осетливи на метронидазол, ванкомицин, даптомици и тигециклин, а единствено соевите од риботипот 018 биле осетливи на на моксифлоксацин. Риботипот 018 е најчестиот риботип и сите изолати од овој риботип покажале резистенција на флуорокинолони, што укажува на тоа дека зголемената употреба на овие антибиотици одиграла главна улога во нивната селекција и ширење.

Епидемии на инфекции со C. difficile, посебно со токсикогни соеви како риботипот NAP1/027, многу често се пријавувани во Европа, САД и Канада.

Клучни зборови


Clostridium difficile; нозокомијални инфекции

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DOI: http://dx.doi.org/10.3889/mmej.2015.50009

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