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

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Kiril Mihajlov
Elena Trajkovska Dokic

Апстракт

Иако во минатото не и Ñе придаваше големо значење на оваа бактерија, Ð´ÐµÐ½ÐµÑ Clostridium difficile е еден од најзначајните агенÑи кои Ñе поврзуваат Ñо инфекции Ñтекнати во болничката Ñредина. Главната причина за ова е големата отпорноÑÑ‚ на Clostridium difficile како кон антибиотици, така и кон други надворешни влијанија како резултат на ÑпоÑобноÑта за Ñпорулација и Ñекако ÑпоÑобноÑта за лачење на токÑини. Во Република Македонија нема податоци за преваленцата на инфекциите Ñо оваа бактерија, ниту е одредена оÑетливоÑта и молекуларната карактеризација на изолираните Ñоеви.

Ðнализирајќи 65 рецензирани трудови од оваа проблематика, најдени Ñо пребарување низ базата на податоци од "žÐŸÐ°Ð±Ð¼ÐµÐ´ централ" добиваме интереÑни Ñознанија за изолираните Ñоеви на Clostridium difficile низ Ñветот, најчеÑто од хоÑпитализирани пациенти Ñо антибиотик аÑоцирана дијареа.

Во Ð¾Ð´Ð½Ð¾Ñ Ð½Ð° дијагнозата Ñе препорачува триделниот алгоритам (директен Ñкрининг на глутамат дехидрогеназа-ГДХ, Ð¿Ð»ÑƒÑ Ñ„ÐµÐºÐ°Ð»Ð½Ð° детекција на токÑините Ри Ð’ и токÑикогена култура) како мошне ефикаÑен начин за детекција на овие инфекции. Со него би Ñе опфатиле многу Ñлучаи кои би биле пропуштени Ñо другите алгоритми. МожноÑта од детекција на повеќе Ñлучаи го намалува бројот на Ñлучаи по пат на транÑмиÑија во болниците, а Ñо тоа и вкупните трошоци како резултат на пролонгирана хоÑпитализација.

Стандардна терапија за инфекции Ñо C. difficilе е орално метронидазол или ванкомицин. Пациентите Ñо тешки и рефракторни инфекции Ñо C. difficilе уÑпешно Ñе третираат интравенÑки Ñо тигециклин. Тигециклин има најниÑки вредноÑти за MИК90 за C. difficile, а понатаму Ñледат даптомицин, метронидазол и ванкомицин (1 μg/ml). Клиндамицинот покажал највиÑоки МИК вредноÑти од Ñите теÑтирани антимикробни агенÑи. Употребата на клиндамицин е поврзана Ñо виÑок ризик за индуцирање на инфекција Ñо C. difficilе.

Во поголемиот број Ñтудии, Ñите Ñоеви биле оÑетливи на метронидазол, ванкомицин, даптомици и тигециклин, а единÑтвено Ñоевите од риботипот 018 биле оÑетливи на на мокÑифлокÑацин. Риботипот 018 е најчеÑтиот риботип и Ñите изолати од овој риботип покажале резиÑтенција на флуорокинолони, што укажува на тоа дека зголемената употреба на овие антибиотици одиграла главна улога во нивната Ñелекција и ширење.

Епидемии на инфекции Ñо C. difficile, поÑебно Ñо токÑикогни Ñоеви како риботипот NAP1/027, многу чеÑто Ñе пријавувани во Европа, СÐД и Канада.

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Како да се цитира
Mihajlov, K., & Trajkovska Dokic, E. (2015). Соеви на Clostridium difficile асоцирани со нозокомијални инфекции – лабораториска дијагноза, преваленца, осетливост и молекуларна карактеризација на изолатите. Македонско медицинско електронско списание, 2015, 1–8. https://doi.org/10.3889/mmej.2015.50009
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