Infectie clostridium difficile

1. PROBIOTICELE
- Nu se recomanda in preventia CDI impreuna cu tratamentul antibiotic

Probioticele sunt microorganism vii care atunci cand sunt administrate in cantitati adecvate
confera beneficiu gazdei. Mecanismele propuse : colonizarea si normalizarea microbiotei
intestinale perturbate; modularea sistemului imun si a functiilor metabolice care mentin
integritatea florei intestinale;

Tratament:

1. Vanco 125mg x4/zit imp de 10 zile – primul episod CDI non sever
2. Fidaxomicina 200mg x2/zi 10 zile
3. Metronidazol 500mg x3/zi 1- zile – primul episode non sever la pacienti low risk
4. CDI sever- Vanco 125mg x 4/zi 1- zile
5. CDI fulminanta – Vanco 500mg la 6h pt primele 48-72h. Combinatie cu MDZ 500mg x3/zi
poate fi considerate
6. In caz de ileus – Vanco clisme 500mg la 6h

In caz de recurenta :

7. Transplant fecal – pacienti cu CDI severa sau fulminanta si refractara la antibiotic

8. Se recom tapering Vanco pt prima recurenta dupa un prim episode tratat cu Vanco
9. FMT – prin colonoscopie
10. Repet FMT la CDI recurenta la 8 saotamani dupa primul FMT

CDI severa - WBC >15.000 + creatinina >1.5

CDI fulminanta - WBC >15.000 + creatinina >1.5+ hTA/soc/ileus/megacolon

Glutamate dehydrogenase (GDH) is an enzyme produced in large amounts by both toxigenic and
nontoxigenic strains of C. difficile and other clostridial species.

Non-CDI infection: forme non severe care nu raspund la trat CDI cu vanco – istorie de diaree
cronica, simptome intermitente in absenta tratam, constipatie alternative; sd intestine iritabil
postinfectios dupa trat CDI;

CDI persistent in 56 % pers dupa resolutia diareei – la 4 sapt dupa terminarea tratam – de aceea
nu se testeaza de rutina pt pac asimptomatici dupa tratamentul pt CDI.

SII post infectie CDI este frecvent – 25%