Dijagnostika i značaj infekcije uzrokovane bakterijom clostridium difficile

master's thesis

• Title (english): Diagnostics and importance of clostridium difficile infections
• Author: Lovro Skrba
• Mentor: Ana Budimir (mentor)
• Committee member: Zrinka Bošnjak (predsjednik povjerenstva)
• Committee member: Goran Tešović (član povjerenstva)
• Committee member: Ana Budimir (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Medical Microbiology and Parasitology); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Medical Microbiology

Abstract

Clostridium difficile(C. difficile) najčešći je uzročnik postantimikrobnog proljeva
(dijareje), obično povezanog s bolničkim liječenjem. Proljev uzrokovan bakterijom C. difficile
jedan je u spektru kliničkih entiteta povezanih s infekcijom C. difficile (engl. Clostridium
difficile infection, CDI); osim proljeva infekcija može ostati asimptomatska ili dovesti do stanja
poput pseudomembranoznog kolitisa i rjeđe, fulminantnog kolitisa i sepse. U rizične
čimbenike za pojavu bolesti ubrajaju se starija životna dob, teške kronične bolesti,
dugotrajan boravak u bolnici, kao i boravak u ustanovama za starije osobe i kronične
bolesnike. C. difficile prisutan je posvuda u okolišu (u tlu, vodi, životinjama), a dio populacije
su asimptomatski kliconoše; nalazi se u 15% do 70% novorođenčadi i u 2% do 3% odrasle
populacije. Glavni poticajni čimbenik za razvoj infekcije je promjena crijevne flore uzrokovana
primjenom antibiotika. Iako većina antibiotika može dovesti do CDI, najveći je rizik kod
upotrebe cefalosporina, penicilina i klindamicina, i u novije vrijeme, fluorokinolona.
Mikroorganizmi u promijenjenoj crijevnoj okolini rastu i proizvode toksine koji oštećuju
crijevnu sluznicu dovodeći do sekrecije tekućine i proljeva, a u težim slučajevima i do
formiranja pseudomembrana na njenoj površini. Dijagnoza se postavlja nalazom toksina u
stolici, a simptomatski se bolesnici liječe peroralno metronidazolom ili vankomicinom. Za
smanjenje širenja infekcije među bolesnicima i zdravstvenim djelatnicima neophodno je
primjenjivati mjere za kontrolu infekcije.

Abstract (english)

Clostridium difficile(C. difficile) is the most common cause of antibiotic-associated
diarrhoea, usually occuring during the hospital care. C.difficile-associated diarrhoea belongs
to a spectrum of clinical entities associated with C. difficile infection, CDI; aside from
diarrhoea, infection can remain symptomless or it can lead to other conditions, such as
pseudomembranous colitis or, rarely, fulminant colitis and sepsis. Risk factors for the disease
include older age, severe chronic conditions, long hospital stay and association with other
healthcare facilities.C. difficile is omnipresent in the environment (in soil, water and animals)
with a part of population being asymptomatic carriers; the bacterium can be isolated in 40%
– 60% of infants and 2% – 4% of adults. The main inciting factor for the infection is the
alteration of normal gut flora caused by the use of antibiotics. Virtually any antibiotic can lead
to C. difficile infection, but the risk is highest with the use of cephalosporins, penicilins,
clindamycin and recently, fluoroquinolons. In such altered environment, the microorganisms
thrive and produce toxins which damage the intestinal mucosa leading to fluid secretion and
diarrhoea, and in more severe cases plaques called pseudomembranes form on the surface
of the intestine. Diagnosis is based on detection of clostridial toxins in the stool and
symptomatic patients are treated with oral metronidazole or vancomycin. The implementation
of infection control measures is essential to reduce the spread of infection among patients
and healthcare workers.

• Keywords: C. difficile; proljev; antibiotici; crijevna flora; toksini
• Keywords (english): C. difficile; diarrhoea; antibiotics; gut flora; toxins
• Language: croatian
• URN:NBN: urn:nbn:hr:105:565937
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-28 10:44:18