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  • 1 Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Belgyógyászati Intézet, Intenzív Terápiás Osztály Debrecen Nagyerdei krt. 98. 4032
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Az utóbbi években a hipervirulens és antibiotikum-rezisztens Clostridium difficile törzsek nemzetközi elterjedésével párhuzamosan a fertőzés előfordulása hazánkban is drasztikusan növekszik, sajnos, riasztó mortalitási mutatókkal és recidívaaránnyal. A szerzők 59 éves, antibiotikumokkal előkezelt beteg Clostridium difficile fertőzés okozta súlyos, recidív pseudomembranosus colitiséről számolnak be. Az álhártyás bélgyulladás fulmináns, életet veszélyeztető tüneteit intenzív ellátással, metronidazol- és vancomycinadással, megfelelő szupportív terápiával, elhúzódó konvencionális kezeléssel néhány hét alatt rendezték. A rövid, egy hét múltán bekövetkezett, jól dokumentált újabb súlyos klinikai recidíva ellátására kolonoszkópos eljárással fekális bakterioterápiát alkalmaztak, amely antibiotikum nélkül teljes gyógyuláshoz vezetett. A sikeres széklettranszplantáció kapcsán érintőlegesen ismertetik a beavatkozás módszertanát, az indikáció kérdéseit. Kitérnek a Clostridium difficile infekció bakteriológiai, epidemiológiai vonatkozásaira, az antibiotikum terápia problémáira, hangsúlyozzák a fekális bakterioterápia költséghatékonyságát. A széklettranszplantáció szakmai protokolljának kidolgozására és az eljárás széles körű bevezetésére sarkallják az illetékes hazai szakmai társaságokat. Orv. Hetil., 2012, 153, 2077–2083.

  • Bartlett, J. G.: Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann. Intern. Med., 2006, 145, 758–764.

    Bartlett J. G. , 'Narrative review: the new epidemic of Clostridium difficile-associated enteric disease ' (2006 ) 145 Ann. Intern. Med. : 758 -764.

    • Search Google Scholar
  • Terhes, G., Urbán, E., Konkoly-Thege, M., et al.: First isolation of Clostridium difficile PCR ribotype 027 from a patient with severe persistent diarrhoea in Hungary. Clin. Microbiol. Infect., 2009, 15, 885–886.

    Konkoly-Thege M. , 'First isolation of Clostridium difficile PCR ribotype 027 from a patient with severe persistent diarrhoea in Hungary ' (2009 ) 15 Clin. Microbiol. Infect. : 885 -886.

    • Search Google Scholar
  • Freeman, J., Bauer, M. P., Baines, S. D., et al.: The changing epidemiology of Clostridium difficile infections. Clin. Microbiol. Rev., 2010, 23, 529–549.

    Baines S. D. , 'The changing epidemiology of Clostridium difficile infections ' (2010 ) 23 Clin. Microbiol. Rev. : 529 -549.

    • Search Google Scholar
  • Wiegand, P. N., Nathwani, D., Wilcox, M. H., et al.: Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquird infection. J. Hosp. Infec., 2012, 81, 1–14.

    Wilcox M. H. , 'Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquird infection ' (2012 ) 81 J. Hosp. Infec. : 1 -14.

    • Search Google Scholar
  • Martinez, F. J., Leffler, D. A., Kelly, C. P.: Clostridium difficile outbreaks: prevention and treatment strategies. Risk Manag. Healthc. Policy, 2012, 5, 55–64.

    Kelly C. P. , 'Clostridium difficile outbreaks: prevention and treatment strategies ' (2012 ) 5 Risk Manag. Healthc. Policy : 55 -64.

    • Search Google Scholar
  • Petrella, L. A., Sambol, S. P., Cheknis, A., et al.: Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain. Clin. Infect. Dis., 2012, 55, 351–357.

    Cheknis A. , 'Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain ' (2012 ) 55 Clin. Infect. Dis. : 351 -357.

    • Search Google Scholar
  • Vardakas, K. Z., Polyzos, K. A., Patouni, K., et al.: Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence. Int. J. Antimicrob. Agents, 2012, 40, 1–8.

    Patouni K. , 'Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence ' (2012 ) 40 Int. J. Antimicrob. Agents : 1 -8.

    • Search Google Scholar
  • Kelly, C. R., Leon, L., Jasutkar, N.: Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results. J. Clin. Gastroenterol., 2012, 46, 145–149.

    Jasutkar N. , 'Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results ' (2012 ) 46 J. Clin. Gastroenterol. : 145 -149.

    • Search Google Scholar
  • Tvede, M., Rask-Madsen, J.: Bacteriotherapy for chronic relapsing Clostridium difficile diarrhea in six patients. Lancet, 1989, 1 (8648), 1156–1160.

    Rask-Madsen J. , 'Bacteriotherapy for chronic relapsing Clostridium difficile diarrhea in six patients ' (1989 ) 1 Lancet : 1156 -1160.

    • Search Google Scholar
  • Grehan, M. J., Borody, T. J., Leis, S. M., et al.: Durable alteration of the colonis microbiota by the administration of donor fecal flora. J. Clin. Gastroenterol., 2010, 44, 551–561.

    Leis S. M. , 'Durable alteration of the colonis microbiota by the administration of donor fecal flora ' (2010 ) 44 J. Clin. Gastroenterol. : 551 -561.

    • Search Google Scholar
  • Gough, E., Shaikh, H., Manges, A. R.: Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin. Infect. Dis., 2011, 53, 994–1002.

    Manges A. R. , 'Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection ' (2011 ) 53 Clin. Infect. Dis. : 994 -1002.

    • Search Google Scholar
  • Guo, B., Harstall, C., Louie, T., et al.: Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment. Pharmacol. Ther., 2012, 35, 865–875.

    Louie T. , 'Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease ' (2012 ) 35 Aliment. Pharmacol. Ther. : 865 -875.

    • Search Google Scholar
  • Yamagouchi, M., Ohta, A., Tsunematsu, T., et al.: Preliminary criteria for classification of adult Still’s disease. J. Rheumatol., 1992, 19, 424–430.

    Tsunematsu T. , 'Preliminary criteria for classification of adult Still’s disease ' (1992 ) 19 J. Rheumatol. : 424 -430.

    • Search Google Scholar
  • Koretz, R. L.: ACP Journal Club: review: Proton-pump inhibitors are associated with increased risk for Clostridium difficile infection. Ann. Intern. Med, 2012, 157, JC2–JC13.

    Koretz R. L. , 'ACP Journal Club: review: Proton-pump inhibitors are associated with increased risk for Clostridium difficile infection ' (2012 ) 157 Ann. Intern. Med : JC2 -JC13.

    • Search Google Scholar
  • Ingle, M., Deshmukh, A., Desai, D., et al.: Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: a retrospective analysis. Indian J. Gastroenterol., 2011, 30, 89–93.

    Desai D. , 'Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: a retrospective analysis ' (2011 ) 30 Indian J. Gastroenterol. : 89 -93.

    • Search Google Scholar
  • Urbán, E., Tusnádi, A., Terhes, G., et al.: Prevalence of gastrointestinal disease caused by Clostridium difficile in a university hospital in Hungary. J. Hosp. Infect., 2002, 51, 175–178.

    Terhes G. , 'Prevalence of gastrointestinal disease caused by Clostridium difficile in a university hospital in Hungary ' (2002 ) 51 J. Hosp. Infect. : 175 -178.

    • Search Google Scholar
  • Sujatha, S., Praharaj, I.: Glycopeptide resistance in Gram-positive cocci: a review. Interdiscip. Perspekt. Infect. Dis., 2012, 2012, 781679.

    Praharaj I. , 'Glycopeptide resistance in Gram-positive cocci: a review ' (2012 ) 2012 Interdiscip. Perspekt. Infect. Dis. : 781679 -.

    • Search Google Scholar
  • Chang, S., Sievert, D. M., Hageman, J. C., et al.: Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene. N. Engl. J. Med., 2003, 348, 1342–1347.

    Hageman J. C. , 'Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene ' (2003 ) 348 N. Engl. J. Med. : 1342 -1347.

    • Search Google Scholar
  • Weigel, L. M., Clewell, D. B., Gill, S. R., et al.: Genetic analysis of a high-level vancomycin-resistant isolate of Staphylococcus aureus. Science, 2003, 302, 2569–1571.

    Gill S. R. , 'Genetic analysis of a high-level vancomycin-resistant isolate of Staphylococcus aureus ' (2003 ) 302 Science : 2569 -1571.

    • Search Google Scholar
  • Yamaguchi, Y., Hanaki, H., Yanagisawa, C., et al.: Characterization of beta-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR) in a patient with septicemia during long-term vancomycin administration. J. Infect. Chemother., 2009, 15, 274–278.

    Yanagisawa C. , 'Characterization of beta-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR) in a patient with septicemia during long-term vancomycin administration ' (2009 ) 15 J. Infect. Chemother. : 274 -278.

    • Search Google Scholar
  • Méhes, L., Taskó, S., Székely, A., et al.: Phagocytosis and intracellular killing of heterogeneous vancomycin-intermediate Staphylococcus aureus strains. J. Med. Microbiol., 2012, 61 (Pt2), 198–203.

    Székely A. , 'Phagocytosis and intracellular killing of heterogeneous vancomycin-intermediate Staphylococcus aureus strains ' (2012 ) 61 J. Med. Microbiol. : 198 -203.

    • Search Google Scholar
  • Aroniadis, O. C., Brandt, L. J.: Fecal microbiota transplantation: past, present and future. Curr. Opin. Gastroenterol., 2012 Oct 4. [Epub ahead of print]

  • Eiseman, B., Silen, W., Bascom, G. S., et al.: Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery, 1958, 44, 854–859.

    Bascom G. S. , 'Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis ' (1958 ) 44 Surgery : 854 -859.

    • Search Google Scholar
  • Rohlke, F., Surawicz, C. M., Stollman, N.: Fecal flora reconstitution for recurrent Clostridium difficile infection: results and methodology. J. Clin. Gastroenterol., 2010, 44, 567–570.

    Stollman N. , 'Fecal flora reconstitution for recurrent Clostridium difficile infection: results and methodology ' (2010 ) 44 J. Clin. Gastroenterol. : 567 -570.

    • Search Google Scholar
  • Louie, T. J., Miller, M. A., Mullane, K. M., et al.: Fidaxomicin versus vancomycin for Clostridium difficile infection. N. Engl. J. Med., 2011, 364, 422–431.

    Mullane K. M. , 'Fidaxomicin versus vancomycin for Clostridium difficile infection ' (2011 ) 364 N. Engl. J. Med. : 422 -431.

    • Search Google Scholar
  • Cornely, O. A., Miller, M. A., Louie, T. J., et al.: Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin. Infect. Dis., 2012, 55 (Suppl. 2), S154–S161.

    Louie T. J. , 'Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin ' (2012 ) 55 Clin. Infect. Dis. : S154 -S161.

    • Search Google Scholar
  • Mattila, E., Uusitalo-Seppälä, R., Wuorela, M., et al.: Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology, 2012, 142, 490–496.

    Wuorela M. , 'Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection ' (2012 ) 142 Gastroenterology : 490 -496.

    • Search Google Scholar

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