Zusammenfassung
Die häufigste Ursache für antibiotikaassoziierte Diarrhöen ist die Kolitis durch Clostridium difficile. Der Erreger kann leicht nosokomial übertragen werden. Fast jede Antibiotikatherapie ist möglicher Auslöser einer solchen Kolitis. Das Spektrum der Erkrankung reicht von wässrigen Diarrhöen bis hin zu schweren nekrotisierenden Kolitiden mit septischem Verlauf. Schwere Verlaufsformen mit schlechter Prognose sind in den letzten Jahren zunehmend häufiger beschrieben worden. Die Diagnose kann entweder durch den Nachweis des Toxins aus Stuhl, kulturell oder endoskopisch gestellt werden. Die Endoskopie zeigt eine Kolitis mit meist distalem Befall, pathognomonisch ist der Nachweis von Pseudomembranen. Zwei Substanzen stehen zur Therapie zur Verfügung: Metronidazol und Vancomycin. Weitere Substanzen befinden sich in der klinischen Prüfung. Rezidive nach Absetzen der Therapie sind häufig, die Rate kann durch Rekonstitution der Normalflora verringert werden.
Abstract
The most relevant cause of antibiotic therapy-associated diarrhea is Clostridium difficile. C. difficile can readily be transmitted nosocomially and colonize the colon. C. difficile colitis can be caused by almost any antibiotic therapy. The production of toxins leads to colitis with a spectrum ranging from watery diarrhea to necrotizing colitis with a septic course. Severe forms of the disease have been reported with increasing frequency over the last few years. C. difficile colitis can be diagnosed by the typical presentation, combined with detection of toxins in stool specimen, culturally or endoscopically. The typical endoscopic presentation is severe distal colitis with pseudomembranes. Two antibiotic agents are currently licensed for drug therapy of C. difficile colitis: vancomycin and metronidazole. Newer substances are currently in clinical development. Even with successful therapy, recurrent episodes are frequent and require additional therapeutic courses. Reconstitution of normal intestinal flora seems to reduce the rate of recurrence.
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Salzberger, B. Clostridium-difficile-Kolitis. Intensivmed 47, 272–275 (2010). https://doi.org/10.1007/s00390-009-0161-x
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DOI: https://doi.org/10.1007/s00390-009-0161-x
Schlüsselwörter
- Clostridium-difficile-Kolitis
- Antibiotikaassoziierte Diarrhö
- Pseudomembranöse Kolitis
- Vancomycin
- Metronidazol