A+ A A-

Download article

Nemtsov L.M.
Pseudomembranous colitis as a multidiscipline problem

Toxin - producing strains of Clostridium difficile are responsible for up to 20% of all of antibiotic-associated diarrheas (AАD) and 40-45% of cases of nosocomial AAD in the countries of Europe and North America with a high risk of the development of pseudomembranous colitis (PMC) and life-threatening complications, especially in  case of delayed diagnosing and inadequate therapy. AАD caused by Clostridium difficile is a multi-discipline problem concerning many branches of medicine, including not only epidemiology, clinical microbiology and infectious diseases, but also gastroenterology, abdominal surgery, oncology, intensive care, and some others. This article provides a survey of researches on the diagnosis, treatment and prevention of PMC. Recently PMC has become a common and aggressive hospital infection associated with antibiotic therapy, which may occur in patients with various medical and surgical pathology. The appearance of diarrhea, hyperthermia, hyperleukocytosis and the signs of endogenous intoxication after administered antibiotic therapy should be considered as a ground for targeted diagnosing of Clostridium difficile-associated colitis (PMC) with the use of laboratory tests. Duly diagnosis and appropriate treatment can prevent the development of severe forms of PMC, which are accompanied by complications and sometimes require surgical treatment. To prevent PMС rationalization of schemes and modes of antibiotic therapy is necessary. Adequate awareness of different medical specialists as regards PMC should be an important component of clinical antibiotic therapy for prevention and early detection of it. Treatment of severe and recurrent PMC forms remains a very challenging task because of a limited number of effective medications.
Key words: pseudomembranous colitis, Clostridium difficile, antibiotic-associated diarrhea.


1. Eriukhin IA, Shliapnikov SA, Lebedev VF, Ivanov GA. Psevdomembranoznyi kolit i «kishechnyi sepsis» - sledstvie disbakterioza, vyzvannogo antibiotikami [Pseudomembranous colitis and "intestinal sepsis" - a consequence of dysbiosis caused by antibiotics]. Vestnik khirurgii im. I. I. Grekova. 1997;156(2):108-11.
2. Bogun LV. Antibiotikoassotsiirovannaia diareia [Antibiotic-associated diarrhea]. Klinicheskaia anti-biotikoterapiia. 2006;(3):40-3.  
3. Malov VA. Antibiotikoassotsiirovannye porazheniia kishechnika [Antibiotikoassotsiirovanny lesions of an intestine]. Vrach. 2000;(10):16-9.
4. Петрук МН, Нешитов СП. Псевдомембранозный колит. Хирургия. Журнал имени Н. И. Пирогова Petruk MN, Neshitov SP. Psevdomembranoznyi kolit [Pseudomembranous colitis]. Khirurgiia. Zhurnal imeni N. I. Pirogova. 2009;(4):55-60.
5. Shul'pekova YuO. Antibiotikoassotsiirovannaia diareia [Antibiotic-associated diarrhea]. Rossiiskii meditsinskii zhurnal. 2007;15(6):1-6.
6. Perras C, Tsakonas E, Ndegwa S, Conly J, Valiquette L, Farrah K. Vancomycin or Metronidazole for Treatment of Clostridium difficile Infection: Clinical and Economic Analyses. Ottawa: Canadian Agency for Drugs and Technologies in Health (Technology report); 2011;(136). 144 p.  
7. Gerding DN. Muto CA, Owens RC. Treatment of Clostridium difficile infection. Clin Infect Dis. 2008;46(l):32-42.
8. Nelson RL, Kelsey P, Leeman H, Meardon N, Patel H, Paul K, Rees R, Taylor B, Wood E, Malakun R. Antibiotic treatment for Clostridium difficile-associated diarrhea in adult. Cochrane Database Syst Rev. 2011 Sep;(9):CD004610.
9. Malov VA, Pak SG, Belikov DV. Psevdomembranoznyi kolit [Pseudomembranous colitis]. Lechashchii vrach. 1999;(2-3):4-9.
10. Alfa MJ, Dul T, Beda G. Survey of incidence of Clostridiulm difficile infection in Canadian hospitals and diagnostic approaches. J Clin Microbiol. 1998;(36):2076-80.
11. Branka JE, Vallette G, Jarry A, Bou-Hanna C, Lemarre P, Van PN, Laboisse CL. Early functional effects of Clostridium difficile toxin A on human colonocytes. Gastroenterology. Gastroenterology. 1997 Jun;112(6):1887-94.
12. Bartlett JG, Perl TM. The new Clostridium difficile - what does it mean. N Engl J Med. 2005 Dec;353(23):2503-5.
13. Demin AA, Rudnov VA. Kolit, assotsiirovannyi s Clostridium difficile, posle operatsii po povodu raka tolstoi kishki [The colitis associated with Clostridium difficile, after operations for a colon cancer]. Infektsii v khirurgii. 2007;5(2):29-33.
14. Price AB, Davies DR. Pseudomembranous colitis. J Clin Pathol. 1977 Jan;30(1):1-12.
15. Van Ness MM, Cattau EL Jr. Fulminant colitis complicating antibiotic associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment. Am J Gastroenterol. 1987 Apr;82(4):374-7.
16. Castagliuolo I, Riegler MF, Valenick L, LaMont JT, Pothoulakis C. Saccharomyces boulardii protease inhibits the effects of Clostridium difficile toxins A and B in human colonic mucosa. Infect Immun. 1999 Jan;67(1):302-7.
17.  Plummer S, Weaver MA, Harris JC, Dee P, Hunter J. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhea. Int Microbiol. 2004 Mar;7(1):59-62.
18. Zaplatnikov AL, Zakharova IN, Korovina NA. Clostridium difficile-infektsiia u detei [Clostridium difficile-infection in children]. Russkii meditsinskii zhurnal. 2004;12(5):373-6.
19.  Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH. Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010 May;31(5):431-55.
20. Bobo LD, Dubberke ER, Kollef M. Clostridium difficile in the ICU: the struggle continues. Chest. 2011 Dec;140(6):1643-53.
21. Guide to the Elimination of Clostridium difficile in Healthcare Settings. Washington, DC: Association for Infection Control Professionals; 2008. 66 p.
22. Dubberke ER, Butler AM, Reske KA, Agniel D, Olsen MA, D’Angelo G, McDonald LC, Fraser VJ. Attributable outcomes of endemic Clostridium difficule-associated disease in nonsurgical patients. Emerge Infec. Dis. 2008 Jul;14(7):1031-8.
23. Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, Bourgault AM, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson TJ, Horn R, René P, Monczak Y, Dascal A. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005 Dec;353(23):2442-9.
24. Pépin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005 Oct;173(9):1037-42.
25. Zilberberg MD, Shorr AF, Kollef MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis. 2008 Jun;14(6):929-31.
26. Ghantoji SS, Sail K, Lairson DR, DuPont HL, Garey KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect. 2010 Apr;74(4):309-18.
27. Lawrence SJ, Puzniak LA, Shadel BN, Gillespie KN, Kollef MH, Mundy LM. Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol. 2007 Feb;28(2):123-30.
28. Zerey M, Paton BL, Lincourt AE, Gersin KS, Kercher KW, Heniford BT. The burden of Clostridium difficile in surgical patients in the United States. Surg Infect. 2007 Dec;8(6):557-66.
29. Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis. 2002 Feb;34(3):346-53.
30. O'Brien JA, Lahue BJ, Caro JJ, Davidson DM. The emerging infectious challenge of Clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol. 2007 Nov;28(11):1219-27.
31. McCollum DL, Rodriguez MJ. Diagnostika, lechenie i profilaktika infektsii, vyzvannoi Clostridium difficile [Diagnosis, treatment and prevention of infection caused by Clostridium difficile]. Klinicheskaia gastroenterolo-giia i gepatologiia. 2012;5(4):169-82.
32. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol. 2007 Feb;28(2):140-5.
33. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, Harmsen WS, Zinsmeister AR. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2012 Jan;107(1):89-95.
34. Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE. Comparison of real-time PCR for detection of the tcdC gene with four toxin immunoassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol. 2008 Jun;46(6):1996-2001.
35. Alekseechkina OA, Dubrov EIa, Vladimirova ES, Pinchuk TP, Titova GP. Vozmozhnosti ul'trazvukovogo issledovaniia v diagnostike psevdomembranoznogo kolita u khirurgicheskikh bol'nykh [Possibility of ultrasound in the diagnosis of pseudomembranous colitis in surgical patients]. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. 2012;21(2):29-35.
36. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland LV, Mellow M, Zuckerbraun BS. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013 Apr;108(4):478-98.
37. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, Gorbach S, Sears P, Shue YK. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011 Feb;364(5):422-31.
38. Musher DM, Logan N, Hamill RJ, Dupont HL, Lentnek A, Gupta A, Rossignol JF. Nitazoxanide for the treatment of Clostridium difficile colitis. Clin Infect Dis. 2006 Aug;43(4):421-7.
39. Musher DM, Logan N, Bressler AM, Johnson DP, Rossignol JF. Nitazoxanide versus vancomycin in Clostridium difficile infection: a randomized, double-blind study. Clin Infect Dis. 2009 Feb;48(4):41-6.
40. Johnson S, Schriever C, Galang M, Kelly CP, Gerding DN. Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis. 2007 Ma;44(6):846-8.
41. Johnson S, Schriever C, Patel U, Patel T, Hecht DW, Gerding DN. Rifaximin redux: treatment of recurrent Clostridium difficile infections with rifaximin immediately post-vancomycin treatment. Anaerobe. 2009 Dec;15(6):290-1.
42. Garey KW, Ghantoji SS, Shah DN, Habib M, Arora V, Jiang ZD, DuPont HL. A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. J Antimicrob Chemother. 2011 Dec;66(12):2850-5.
43. Mogg GA, George RH, Youngs D, Johnson M, Thompson H, Burdon DW, Keighley MR. Randomized controlled trial of colestipol in antibiotic-associated colitis. Br J Surg. 1982 Mar;69(3):137-9.
44. Kurtz CB, Cannon EP, Brezzani A, Pitruzzello M, Dinardo C, Rinard E, Acheson DW, Fitzpatrick R, Kelly P, Shackett K, Papoulis AT, Goddard PJ, Barker RH Jr, Palace GP, Klinger JD. GT160-246, a toxin binding polymer for treatment of Clostridium difficile colitis. Antimicrob Agents Chemother. 2001 Aug;45(8):2340-7.
45. Taylor NS, Bartlett JG. Binding of Clostridium difficile cytotoxin and vancomycin by anion-exchange resins. J Infect Dis. 1980 Jan;141(1):92-7.
46. Lowy I, Molrine DC, Leav BA, Blair BM, Baxter R, Gerding DN, Nichol G, Thomas WD Jr, Leney M, Sloan S, Hay CA, Ambrosino DM. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med. 2010 Jan;362(3):197-205.
47. Ho N, Prasad V. Lacking the incentive to cure? Recurring Clostridium difficile diarrhea and our reluctance to use fecal transplantation. J Clin Gastroenterol. 2011 Apr;45(4):379-80.
48.  Silverman MS, Davis I, Pillai DR. Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clin Gastroenterol Hepatol. 2010 May;8(5):471-3.

Поиск по сайту