Materiały źródłowe

• #1 Pseudomembranous Colitis: What It Is, Symptoms, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/17718-pseudomembranous-colitis

  The most important way to prevent pseudomembranous colitis is to prevent the spread of C. diff in vulnerable communities, like hospitals and nursing homes. People in these communities are more likely to become infected and to develop more severe symptoms like pseudomembranous colitis. […] Healthcare providers in these settings take special precautions to control C. diff infection: […] Isolation. Healthcare providers isolate people infected with C. diff in their own room, or one shared only with other infected people. They use disposable gloves when they enter the room. […] Handwashing. Frequent handwashing with soap and warm water is the best defense against C. diff, which is resistant to hand sanitizer. Its especially important before handling food. […] Disinfection. Many common disinfectants dont work against C. diff, but chlorine-based products can. Its important to disinfect all surfaces in contact with the infected person.

• #2 Pseudomembranous Colitis Surgery Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/193031-treatment

  For prevention, use antibiotics prudently. Wash hands, and use examination gloves routinely. Clean potentially contaminated surfaces. Use glutaraldehyde disinfection of instruments that come into contact with gastrointestinal secretions. Enteric isolation of patients at risk is recommended. Treatment of asymptomatic carriers is not recommended, because treatment may prolong carriage, which usually resolves spontaneously. […] Passive immunization, which has been effective in animals, may be potentially useful in protecting patients with a high risk of acquiring the disease. Immunologic studies of toxin A, toxin B, and other virulence factors have led to toxoids that have been used for the production of antibodies that might be used to generate a vaccine in this group of patients.

• #3 Pseudomembranous colitis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/pseudomembranous-colitis

  To help prevent the spread of C. difficile, hospitals and other health care facilities follow strict infection-control guidelines. If you have a friend or family member in a hospital or nursing home, don’t be afraid to remind caregivers to follow the recommended precautions. […] Preventive measures include: […] Handwashing. Health care workers should practice good hand hygiene before and after treating each person in their care. In the event of a C. difficile outbreak, using soap and warm water is a better choice for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy C. difficile spores. Visitors to hospitals or nursing homes also should wash their hands with soap and warm water before and after leaving the room or using the bathroom. […] Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and isolation gowns while in the room until at least 48 hours after diarrhea ends.

• #4 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Infection control and good antibiotic stewardship are the cornerstones for reducing the incidence of C. difficile infection in health care and community settings. Infection control requires a robust surveillance system to detect increased infection rates or outbreaks of C. difficile infection; in addition, key preventive strategies include use of contact precautions, good hand hygiene, environmental cleaning and disinfection, and patient bathing. Contact precautions (e.g., private rooms with a private bathroom, putting on gloves and gowns on entry to the patient’s room and removing them before exiting) should commence when C. difficile infection is suspected and should continue for at least 48 hours after resolution of the patient’s diarrhea. […] […] In routine or endemic settings, hands should be cleaned with either soap and water or an alcohol-based product before and after contact with a patient and after removing gloves. During outbreaks or when direct contact with feces is likely, the use of soap and water is preferred over alcohol-based products based on two small studies that showed that using soap and water vs. alcohol-based products was more effective for reducing C. difficile colony-forming units. U.S. Environmental Protection Agency-registered sporicidal agents should be used to disinfect surfaces with which the patient has come into contact. Disposable equipment such as stethoscopes and thermometers should be used, and patients should wash their hands and shower regularly to reduce the number of spores on the skin. In a study of patients with C. difficile infection, showering significantly reduced positive C. difficile skin cultures vs. bed bathing. […]

• #5 Pseudomembranous colitis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/pseudomembranous-colitis

  Thorough cleaning. In any setting, all surfaces should be carefully disinfected with a product that contains chlorine bleach to destroy C. difficile spores. […] Use antibiotics only when necessary. Antibiotics are sometimes prescribed for viral illnesses that aren’t helped by these drugs. Take a wait-and-see attitude with simple ailments. If you do need an antibiotic, ask your health care provider to prescribe one that has a narrow range and that you take for the shortest time possible.

• #6 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  In community and childcare settings, patients with C. difficile infection should wash their hands with soap and water after using the bathroom, before eating or preparing food, and when hands are visibly soiled. Patients with diarrhea should avoid using the same toilets as other family members, and the bathroom and kitchen should be cleaned with bleach-containing solutions. The Centers for Disease Control and Prevention provides guidance for cleaning products and for preventing contamination of medical equipment. […] […] Antibiotic stewardship that targets restriction of high-risk antibiotics can help control outbreaks and reduce infection rates; multiple studies have shown reductions of 33% to 90%. Similar to inpatient management, outpatient management relies on implementing an antibiotic stewardship program and minimizing the frequency and duration of antibiotic therapy, as well as the number of antimicrobial agents used. Hand washing and barrier precautions should also be used in the outpatient setting. […]

• #7 Clostridium difficile–Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0301/p921.html/1000

  Prevention of C. difficile infection is challenging. Established guidelines should be followed to minimize exposure to the pathogen, particularly in debilitated patients. Preventive measures include the judicious use of antibiotics, hand washing between patient contacts, rapid detection of C. difficile by immunoassays for toxins A and B, isolation of patients who have C. difficile associated diarrhea, use of precautions when in contact with the patient and surrounding environment, proper disinfection of objects (e.g., sodium hypochlorite, alkaline glutaraldehyde, ethylene oxide), education of staff members, and use of continued precautions until the diarrhea ceases. […] A multidiscipline antibiotic management program to restrict the inappropriate use of antibiotics (e.g., third-generation cephalosporins) can lead to a significant decrease in nosocomial infections caused by C. difficile. In particular, restriction of clindamycin use has been shown to decrease the incidence of C. difficile associated diarrhea. Family physicians can do much to decrease the occurrence of C. difficile mediated disease by restricting the use of broad-spectrum antibiotics in their patients.

• #8 Antibiotic Associated Colitis | Pediatric Surgery NaT

  https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829028/all/Antibiotic_Associated_Colitis

  Antibiotic stewardship and avoidance of antibiotics, if possible, is another essential step in preventing new cases of CDC. Widespread antibiotic use has not only provided an environment for the germination of spores but has contributed to multidrug resistance of C. difficile strains. The recent isolates, including NAP1, are resistant to modern antibiotics, particularly fluoroquinolones, which is not the case with the historical controls. Fluoroquinolones have been shown to contribute to the emergence of epidemic strains and limiting their use is essential in disease prevention. […] Earlier studies had suggested that particular antibiotics, such as clindamycin, were mainly responsible for emergence of CDC. We now know that many antibiotics can be implicated including erythromycin, tetracycline, and rifampin. As new resistance patterns emerge multidrug resistant species are becoming a norm lending C. difficile an additional advantage over other susceptible intestinal flora. Most C. difficile are susceptible to metronidazole and vancomycin although metronidazole-resistant strains are being reported in Europe further stressing the importance of infection control and prevention.

• #9 Clostridium difficile (C. diff) infection

  https://www.nhs.uk/conditions/c-difficile/

  C. diff infections can spread very easily. There are some things you can do to reduce the risk of passing it on to others. […] stay at home until at least 48 hours after your diarrhoea stops […] wash your hands regularly using soap and water […] clean the toilet and area around it with disinfectant after each use […] wash clothes and sheets with poo on separately from other washing at the highest possible temperature […] do not share towels and flannels […] do not take medicine to stop diarrhoea like loperamide because it can prevent the infection being cleared from your body.

• #10 HIE Multimedia – Pseudomembranous colitis

  https://ssl.adam.com/content.aspx?productid=117&pid=1&gid=000259&site=chifranciscan.adam.com&login=CHI_1977

  People who have had pseudomembranous colitis should tell their providers before taking antibiotics again. […] It is also very important to wash hands well to prevent passing the germ to other people. Alcohol sanitizers do not always work on C difficile.

• #11 HIE Multimedia – Pseudomembranous colitis

  https://ssl.adam.com/content.aspx?productid=117&pid=1&gid=000259&site=chifranciscan.adam.com&login=CHI_1977

  People who have had pseudomembranous colitis should tell their providers before taking antibiotics again. […] It is also very important to wash hands well to prevent passing the germ to other people. Alcohol sanitizers do not always work on C difficile.

• #12 Pseudomembranous colitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/diagnosis-treatment/drc-20351439

  Some research suggests that concentrated supplements of good bacteria and yeasts, called probiotics, can help prevent C. difficile infection, but more studies are needed to determine their use in treating recurrences. […] Drink plenty of fluids. Water is best, but fluids with added sodium and potassium, known as electrolytes, also may be beneficial. […] Don’t eat foods that worsen symptoms. Stay away from spicy, fatty or fried foods, and any other foods that make your symptoms worse. […] The U.S. Food and Drug Administration (FDA) has approved the use of the human monoclonal antibody bezlotoxumab to reduce the risk of recurrence of C. difficile infection. Used in combination with antibiotics, bezlotoxumab has been shown to significantly reduce the recurrence of infection. However, cost may be a limiting factor.

• #13 Clostridioides (formerly Clostridium) difficile–Induced Diarrhea – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-diarrhea

  Antibiotic therapy can cause intestinal overgrowth of toxin-secreting C. difficile, resulting in a pseudomembranous colitis that can be severe and difficult to cure. […] Infection control measures are vital to reduce the spread of C. difficile among patients and health care workers. […] A human monoclonal antibody, bezlotoxumab 10 mg/kg IV given once, binds to and neutralizes C. difficile toxin B; it can be used for prevention of recurrent C. difficile induced diarrhea along with standard-of-care treatment in patients who have had a recurrence within the last 6 months. […] If possibly causative antibiotics are being used, they should be stopped as soon as possible, or patients should be switched to an antibiotic regimen less likely to cause C. difficile induced diarrhea.

• #14 Pseudomembranous Colitis | Concise Medical Knowledge

  https://www.lecturio.com/concepts/pseudomembranous-colitis/

  Prevention of hospital transmission: […] – Gloving of personnel […] – Isolation of the patient with designated bathroom facilities […] – Avoiding the use of contaminated electronic thermometers and stethoscopes […] – Use of hypochlorite (bleach) solution to decontaminate the rooms of patients […] – Hand washing with soap (alcohol-containing hand gels are not sporicidal) […] – Restricting the use of specific antibiotics: […] – Clindamycin […] – 2nd- and 3rd-generation cephalosporins […] […] […] Bezlotoxumab to prevent recurrence in those with high risk.

• #15 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  A multifactorial approach is recommended for the prevention of CDI. This includes infection prevention measures (e.g., hand hygiene, isolation precautions, contact precautions, and appropriate environmental cleaning and disinfection) as well as implementation of antimicrobial stewardship programs that restrict high-risk antibiotics and focus on minimizing the use and duration of unnecessary antimicrobial agents. […] The updated ACG guidelines state that the use of oral vancomycin as prophylaxis (to prevent recurrence) may be considered in patients with a recent history of CDI who require antibiotic treatment and are at high risk for recurrent infection (i.e., aged 65 years or older or significantly immunocompromised and hospitalized within the previous 3 months for severe CDI); this is a conditional recommendation with a low quality of evidence. The suggested dosage of vancomycin for prophylaxis is 125 mg orally once daily, continued for 5 days after completion of antibiotic therapy.

• #16 Updated Clinical Practice Guidelines for C difficile Infection in Adults

  https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-c-difficile-infection-in-adults

  Additionally, long-term suppression with oral vancomycin may be used in patients with recurrent CDI who are not candidates for FMT, developed a recurrence after FMT, or require antibiotics (either ongoing use or frequent courses); this recommendation is conditional with a very low quality of evidence. The suggested dosage of vancomycin for chronic suppression is 125 mg orally once daily. […] The ACG guidelines advise against the use of probiotics for primary prevention in patients receiving antibiotics or for secondary prevention of CDI recurrence.

• #17 Clostridioides (prev: clostridium) difficile – EMCrit Project

  https://emcrit.org/ibcc/cdiff/

  Recent guidelines have pared back the use of prophylactic antibiotics for most indications. […] Emerging evidence suggests that the duration of antibiotic courses may often be reduced. […] Antibiotics shouldn’t be used blindly except under specific circumstances (e.g., septic shock, neutropenic fever). […] Oral vancomycin prophylaxis should be considered for patients with recent C. difficile infection who must subsequently be treated with systemic antibiotics (placing them at high risk for recurrent C. difficile). […] This may be considered for patients who experienced C. difficile within the previous ~3 months, or for patients with a history of multiple, recurrent episodes of C. difficile. […] One implication of first do no harm is to avoid C. difficile transmission. […] C. difficile spores aren’t sterilized by ethanol-based hand cleansers. Better approaches include the use of gloves and traditional hand-washing.

• #18 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  The use of probiotics for the prevention of C. difficile infection and, more specifically, C. difficile associated diarrhea has also been examined. A 2017 Cochrane review of 39 studies found moderate evidence that probiotics are effective for preventing C. difficile associated diarrhea, but only in trials where the C. difficile event rate was more than 5%. In these studies, probiotics had a number needed to treat of 12 to prevent C. difficile associated diarrhea. Investigators determined that 27 of the studies were at high or unclear risk of bias, and there was marked heterogeneity between the studies in probiotic formulations, duration of administration, definitions of C. difficile infection, and duration of follow-up. Probiotics may impede recovery of normal gut flora after antibiotic use and increase the risk of bacteremia and fungemia in immunocompromised people. Because of the potential bias and variations in the Cochrane review and the potential for harm from probiotic use, the IDSA concluded that there is insufficient evidence to recommend probiotics as a preventive measure. There is also insufficient evidence to recommend stopping proton pump inhibitors and histamine H2 blockers to decrease the incidence of C. difficile infection. […] […] There is insufficient evidence to recommend screening for asymptomatic carriers of C. difficile, or for instituting contact precautions for asymptomatic carriers. Thus, it is not necessary to screen or treat close contacts if they are asymptomatic.

• #19 Pseudomembranous Colitis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/pseudomembranous-colitis

  Administration of currently available probiotics is not recommended to prevent primary CDI, as there are limited data to support this approach. […] Overall preventative measures, such as strict handwashing and patient isolation policies for patients with diarrhoea, seem to be effective. There is less evidence of benefit for environmental cleansing measures. […] Handwashing should be done correctly to be effective. Alcohol gels do not kill spores and are not recommended. […] Appropriate antibiotic prescribing; minimise the frequency and duration of antimicrobial therapy and the number of antimicrobial agents prescribed.

• #20 Can You Get C. Diff From Taking Antibiotics?

  https://health.clevelandclinic.org/antibiotics-and-c-diff

  Taking antibiotics only when necessary, handwashing and probiotics can help […] The best way to prevent C. diff is to use antibiotics only when necessary. […] Reducing the length of time you take an antibiotic can also help. […] If you need to take them, here are a few suggestions to help prevent C. diff. […] Washing your hands frequently is the best way to protect yourself from C. diff. […] Probiotics are safe and inexpensive, says Dr. Allan. They may help prevent C. diff or reduce symptoms. I recommend probiotics for people taking antibiotics for more than seven days if they are worried about C. diff.

• #21 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridioides-difficile-colitis

  If you’re in a hospital or long-term health care facility, you can do several things to protect yourself from C. diff. For example: […] Another way to help prevent C. diff is to avoid unnecessary antibiotics. Talk this over with your doctor and see if there are other treatment options. And don’t take antibiotics without a doctor’s OK. […] After having C. diff, it’s important to reintroduce „good” bacteria back into your gut. These bacteria, called probiotics, can help limit the growth of C. diff. Fermented foods with live cultures such as yogurt, kefir, miso, and sauerkraut contain probiotics. Probiotics can also be taken as supplements. […] There is limited evidence about the role probiotics play in helping to treat or prevent C. diff. Some data suggests that combinations of the good bacteria Lactobacillus and S. boulardii may help prevent C. diff infections in high-risk patients, but more research is needed.

• #22 Prevention of Clostridium difficile-induced experimental pseudomembranous colitis by Saccharomyces boulardii: a scanning electron microscopic and microbiological study | Microbiology Society

  https://www.microbiologyresearch.org/content/journal/micro/10.1099/00221287-136-6-1085

  The ability of Saccharomyces boulardii to protect mice against intestinal pathology caused by toxinogenic Clostridium difficile was studied. […] The results showed that: (i) 70% of the mice infected by C. difficile survived when treated with S. boulardii; (ii) the C. difficile-induced lesions on the small and large intestinal mucosa were absent or markedly less severe in S. boulardii-treated mice; and (iii) there was no decrease in the number of C. difficile but rather a reduction in the amount of toxins A and B in S. boulardii-treated mice. […] Prevention of Clostridium difficile-induced mortality in gnotobiotic mice by Saccharomyces boulardii.

• #23 Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-consensus-on-prevention-diagnosis-treatment-articulo-S2255534X19300295

  In the cases of initial mild-moderate Clostridium difficile infection, oral vancomycin at a dose of 125mg every 6h is recommended as the treatment of choice. […] The evidence for recommending probiotics in the prevention of CDI or its recurrence is limited to certain strains. […] Fecal microbiota transplantation is a safe and effective option in patients with CDI with two recurrences or in patients with severe episodes and antimicrobial treatment failure. […] There are measures of prevention and control of CDI directed at the interruption of the bacterium’s mechanism of transmission through the hands of patients and healthcare professionals and the handling of surfaces or medical devices contaminated by the bacterial spores. […] The implementation of optimization and education programs on antibiotic use (antimicrobial stewardship), as well as in-hospital epidemiologic controls, environmental decontamination, and hand-washing are measures that have demonstrated a decrease in the incidence of CDI.

• #24 Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2016.14.1.83

  Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. […] Fecal microbiota transplant (FMT) has emerged in recent years as a treatment option for patients with recurrent and antibiotic-refractory PMC, and many studies have achieved favorable results with this procedure. […] New therapeutic approaches have been investigated for the treatment of recurrent and refractory PMC, and a large number of recent studies have explored the use of FMT. […] Although the use of metronidazole failed in the case reported here, the patient was diagnosed with mild PMC due to the absence of high fever or leukocytosis. […] Successful treatment of FMT cases has been reported and several multicenter randomized controlled studies and meta-analyses have demonstrated the favorable results of this procedure.

• #25 Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

  https://www.irjournal.org/journal/view.php?doi=10.5217/ir.2016.14.1.83

  In the future, patients will hopefully accept and understand the benefits of fecal transplantation, even though it may be aesthetically unappealing, through sufficient explanation during interviews by clinicians. […] A donor screening test is warranted to prevent secondary infections caused by the transplantation. […] Bowel cleansing was performed in preparation for the FMT, as described in previous studies. […] Even though the effectiveness of FMT has been demonstrated, the transplantation procedure has not yet been standardized. […] These outcomes provide a basis for expanding donor selection through adequate screening tests. […] In recent years, administration of freeze-dried fecal capsules from donors has lead to more timely and effective FMT, exhibiting successful results in over 90% of urgent-care patients with PMC. […] FMT is expected to be the standard therapy for the management of recurrent and refractory PMC domestically in the future.

• #26

  https://www.cda-adc.ca/jcda/vol-67/issue-1/20.html

  Clostridium difficileinduced diarrhea and colitis are common complications of therapeutic courses of antibiotics in the hospital setting. […] Dental practitioners must be aware of the significance of the disease and the risk associated with antibiotics, whether they are used for prophylaxis or treatment. […] Through this report we hope to heighten awareness among dental practitioners to the significance of the disease and to this risk associated with antibiotics, whether they are used for prophylaxis or treatment. Patients should be informed of the potential for diarrhea with antibiotic prescriptions and be instructed to follow up with their family physician should diarrhea occur within 2 months of therapy. Prudent use of narrow spectrum antibiotics, for the shortest possible duration and in only those patients with well-defined indications for prophylaxis or treatment, will minimize the risk of C. difficile disease. Avoiding the unnecessary use of antibiotics is the most important step that health care prescribers can take to prevent the morbidity and mortality associated with C. difficile disease.

• #27 Beginner’s Guide To Beating Pseudomembranous Colitis (C. diff Colitis): Explained in Plain English

  https://www.linkedin.com/pulse/beginners-guide-beating-pseudomembranous-colitis-c-diff-leech

  Pseudomembranous colitis refers to inflammation in the gut that is associated with an overgrowth of C. diff bacteria. […] This article explores what to eat and drink during a C. diff infection, and what diet can help prevent pseudomembranous colitis from recurring. […] Many doctors recommend sticking with soft, starchy foods, including: […] If you have no appetite, you might find it easier to consume only liquids to start. […] It’s very important to stay well-hydrated. […] To prevent pseudomembranous colitis from recurring, choose foods that benefit your gut bacteria. These include products with probiotics like yogurt (with live active cultures), kefir and sauerkraut. […] Following these recommendations and being consistent with your diet changes and improvements can go a long way to prevent the inflammation from recurring.

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