Antibiotic-associated diarrhoea: risk factors and clinical outcome

Postantimikrobni proljev (AAD) je komplikacija povezana s primjenom antibiotika. Incidencija AAD je različita s obzirom na vrstu antibiotika i čimbenike rizika u bolesnika i varira izmeĎu 5–25%. Clostridium difficile (C. difficile) je najčešći uzročnik AAD koji se pojavljuje u oko 25% slučajeva AAD, a od ostalih uzročnika spominju se još i Clostridium perfringens, Staphylococcus aureus, Candida spp., Klebsiella oxytoca i Salmonella spp. Poremećaj fiziološke crijevne flore koja dovodi do razmnoţavanja patogenih mikroorganizama, toksični i alergijski učinci na sluznicu crijeva te farmakološki učinci na pokretljivost crijeva, mehanizmi su kojim antibiotici mogu dovesti do nastanka AAD. Postantimikrobni proljev moţe izazvati svaki antibiotik no najčešće se kao uzročnici spominju antibiotici širokog spektra kao što cefalosporini, penicilini, klindamicin i fluorokinoloni. Čimbenici rizika koji pogoduju nastanku postantimikrobnog proljeva su: različita stanja imunodeficijencije, starija ţivotna dob, kirurški zahvati (posebno abdominalni), dugotrajna upotreba antibiotika, smanjeno izlučivanje ţelučane kiseline te duljina hospitalizacije. Klinička slika varira i najčešće se prikazuje kratkotrajnim proljevom bez većih znakova upale koji nakon prestanka uzimanja terapije spontano prolazi, no u teţim slučajevima moţe doći i do razvoja po ţivot opasnog kolitisa. U ovom radu prikazane su epidemiološke i kliničke osobitosti odraslih bolesnika hospitaliziranih zbog postantimikrobnog proljeva i bolesti uzrokovane s C. difficile u Klinici za infektivne bolesti “Dr. Fran Mihaljević” u Zagrebu tijekom dvogodišnjeg razdoblja.Antibiotic-associated diarrhea (AAD) is a complication related to the use of antibiotics. The incidence of AAD is different, depending on the type of antibiotic and risk fators, and varies between 5–25%. Clostridium difficile (C. difficile) is the most common cause in 25% of AAD cases, while other causes include Clostridium perfringens, Staphylococcus aureus, Candida spp., Klebsiella oxytoca and Salmonella spp. Disturbed composition and function of normal intestinal flora leads to the overgrowth of pathogen microorganisms, toxic and allergic effects on the intestinial mucosa and pharmacological effect to gut motility are mechanisims which can, with the use of antibiotics lead to AAD. Antibiotic-associated diarrhea can be caused by any antibiotic, but the most frequent causes are broad-spectrum antibiotics, such as cephalosporins, penicillins, clindamycin, and fluoroquinolones. Risk factors that benefit the occurence of AAD are: different types of immunodeficiency, older age, surgical procedures (esp. abdominal), longterm use of antibiotics, decreased gastric acid secretion, and the length of hospital stay. The clinical picture varies and is most frequently depicted with a short term diarrhea that resolves after quitting the antibiotic intake.In more severe cases it can lead to deadly pseudomembranous colitis. This work shows the epidemiological and clinical characteristics of adult patients hospitalized for AAD and CDAD at the University Hospital for Infectious Diseases "Dr. Fran Mihaljevic" in Zagreb during the two-year period