Faktori rizika od pojave relapsa Clostridium difficile infekcije u Kliničkom centru Vojvodina, Srbija: retrospektivna klinička studija

Nadica Kovačević; Radoslava Doder; Tomislav Preveden; Maria  Pete

doi:10.2298/VSP170321119K

Nadica Kovačević Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Radoslava Doder Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Tomislav Preveden Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Maria Pete Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP170321119K

Keywords: clostridium difficile;, infekcija;, recidiv;, faktori rizika.

Abstract

Uvod/Cilj: Incidenca relapsne Clostridium difficile infekcije (CDI) je u poslednje dve decenije u porastu. Cilj rada bio je utvrđivanje faktora rizika od relapsa kod bolesnika sa inicijalnom CDI. Metode. Na Klinici za infektivne bolesti Kliničog centra Vojvodine u Novom Sadu sprovedena je retrospektivna studija u period od januara 2010. do januara 2016. Studijom je obuhvaćeno 488 bolesnika sa inicijalnom CDI koji su lečeni peroralnim vankomicinom (125 mg, četiri puta dnevno) ili peroralnim metronidazolom (400 mg, tri puta dnevno) 10 dana. Nakon završene terapije bolesnici su praćeni 60 dana u cilju utvrđivanja pojave relapsa. U cilju identifikacije faktora rizika od relapsa CDI upoređivane su demografske, kliničke i laboratorijske karakteristike bolesnika sa relapsom u odnosu na bolesnike sa stabilnim kliničkim odgovorom. Rezultati. Relaps CDI je registrovan kod 142/488 (29,09%) bolesnika od kojih je 22.72% lečeno vankomicinom i 36.60% lečeno metronidazolom. Statistički značajan uticaj na relaps CDI su imali komorbiditet kao što su maligna oboljenja (19,52% vs 8,82%, p = 0,023) i postoperativna CDI (25,67% vs 10,29%, p = 0,035), hipoalbuminemija (< 25 g/L) (70,27% vs 41,94%, p = 0,034), konkomitantna antibiotska terapija (50.67% vs 20,29%, p = 0,031). Perzistencija C. difficile toksina u stolici po završenoj terapiji je registrovana kod 22,32% bolesnika lečenih metronidazolom i 9,09% bolesnika lečenih vankomicinom (p = 0,03). Prisustvo toksina C. difficile u stolici nakon uspešno završene terapije inicijalne CDI nije uticalo signifikantno na pojavu relapsa. Zaključak. Naši rezultati pokazuju da faktore rizika od relapsa CDI predstavljaju komorbiditeti (postoperativna CDI, maligniteti), hipoalbuminemija i konkomitantna primena antibiotika. Vankomicin je efikasniji u eliminaciji toksina C. difficile iz kolona. Prisustvo toksina C. difficile u stolici nakon uspešno završene terapije ne utiče signifikantno na pojavu relapsa.

Author Biography

Maria Pete, Clinical Center of Vojvodina, Clinic for Infectious Disease, Novi Sad, Serbia; Univerity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

Lekar opšte prakse

References

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