Acta Endoscopica

, Volume 44, Issue 6, pp 352–357

Place de l’endoscopie dans le diagnostic des diarrhées sévères aux antibiotiques

Mise au Point / Update
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Résumé

La diarrhée associée aux antibiotiques est définie par la survenue d’une diarrhée, due à une infection intestinale favorisée par l’antibiothérapie, pendant un traitement antibiotique ou au décours de celui-là. Les infections à Clostridium difficile (CD) prédominent largement et sont responsables des formes sévères de colites aux antibiotiques, plus rarement des infections à Klebsiella oxytoca ou Salmonella sont en cause. Le diagnostic, suspecté cliniquement, repose d’abord sur les recherches microbiologiques sur prélèvements de selles. La coloscopie garde cependant une place dans le diagnostic de ces affections, car elle permet d’optimiser le diagnostic microbiologique de la diarrhée aux antibiotiques, de démontrer une infection à CD par la recherche de l’aspect pseudomembraneux quasi pathognomonique de colite à CD, et dans les formes sévères l’endoscopie basse permet d’éliminer un diagnostic différentiel et de rechercher des signes endoscopiques de colite grave pour adapter la prise en charge. Pour finir, l’endoscopie a parfois une place thérapeutique avec la décompression de colectasies et l’instillation locale de moyens thérapeutiques. Dans tous les cas, la pratique d’une endoscopie dans le cadre d’une suspicion d’infection à CD devra s’effectuer dans le cadre des précautions d’hygiène recommandées et adaptées à ce germe.

Mots clés

Diarrhée Antibiotiques Endoscopie Clostridium difficile Klebsiella oxytoca 

The place of endoscopy in the diagnosis of severe, antibiotic diarrhea

Abstract

Antibiotic-induced diarrhea is defined by acute onset of diarrhea during or after an antibiotherapy, linked to an intestinal infection induced by the treatment. Clostridium difficile (CD) infections represent the leading cause of antibioticassociated diarrhea and are responsible for severe forms of colitis, less often Klebsiella oxytoca or Salmonella may be involved. Diagnosis, first clinically suspected, is based on laboratory testing on stool samples. However, colonoscopy still has indications in the diagnosis of this antibioticassociated colitis as it can optimize microbiologic diagnosis and demonstrate CD infection when pathognomonic pseudomembranes are observed. In severe cases, lower endoscopy may bring differential diagnosis, and endoscopic signs of severe acute colitis will be searched for adequate management. Finally endoscopy may have therapeutic interest for colonic decompression and intracolonic treatment administration. In any case, hand hygiene, barrier precautions, and disinfection of environmental surfaces in endoscopy rooms are mandatory for patients with known or suspected CD-related infection.

Keywords

Diarrhea Antibiotics Endoscopy Clostridium difficile Klebsiella oxytoca 

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Références

  1. 1.
    Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Brandt LJ. American Journal of Gastroenterology Lecture: Intestinal microbiota and the role of fecal microbiota transplant (FMT) in treatment of C. difficile infection. Am J Gastroenterol. 2013; 108:177–85.PubMedCrossRefGoogle Scholar
  3. 3.
    De La Cochetière MF, Durand T, Lepage P, Bourreille A, Galmiche JP, Doré J. Resilience of the dominant human fecal microbiota upon short-course antibiotic challenge. J Clin Microbiol 2005;43:5588–92.CrossRefGoogle Scholar
  4. 4.
    Beaugerie L, Sokol H. Acute infectious diarrhea in adults: epidemiology and management. Presse Med 2013;42:52–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med 1978;298:531–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Bartlett JG, Perl TM. The new Clostridium difficile-what does it mean? N Engl J Med 2005;353:2503–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Tachon M, Cattoen C, Blanckaert K, Poujol I, Carbonne A, Barbut F, et al. First cluster of C. difficile toxinotype III, PCRribotype 027 associated disease in France: preliminary report. Euro Surveill Bull Eur Sur Mal Transm Eur Commun Dis Bull 2006;11:E060504.1.Google Scholar
  8. 8.
    Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. 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;31:431–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Wu SW, Dornbusch K, Kronvall G. Genetic characterization of resistance to extended-spectrum beta-lactams in Klebsiella oxytoca isolates recovered from patients with septicemia at hospitals in the Stockholm area. Antimicrob Agents Chemother 1999;43:1294–7.PubMedCentralPubMedGoogle Scholar
  10. 10.
    Beaugerie L, Metz M, Barbut F, Bellaiche G, Bouhnik Y, Raskine L, et al. Klebsiella oxytoca as an agent of antibiotic-associated hemorrhagic colitis. Clin Gastroenterol Hepatol 2003;1:370–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Högenauer C, Langner C, Beubler E, Lippe IT, Schicho R, Gorkiewicz G, et al. Klebsiella oxytoca as a causative organism of antibiotic-associated hemorrhagic colitis. N Engl J Med 2006; 355:2418–26.PubMedCrossRefGoogle Scholar
  12. 12.
    Beaugerie L, Flahault A, Barbut F, Atlan P, Lalande V, Cousin P, et al. Antibiotic-associated diarrhoea and Clostridium difficile in the community. Aliment Pharmacol Ther 2003;17:905–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Bartlett JG. Clostridium difficile: history of its role as an enteric pathogen and the current state of knowledge about the organism. Clin Infect Dis 1994;18:S265–S72.PubMedCrossRefGoogle Scholar
  14. 14.
    Blanckaert K, Coignard B, Grandbastien B, Astagneau P, Barbut F. Update on Clostridium difficile infections. Rev Med Interne 2008;29:209–14.PubMedCrossRefGoogle Scholar
  15. 15.
    Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Barbut F, Gariazzo B, Bonné L, Lalande V, Burghoffer B, Luiuz R, et al. Clinical features of Clostridium difficile-associated infections and molecular characterization of strains: results of a retrospective study, 2000–2004. Infect Control Hosp Epidemiol 2007; 28:131–9.PubMedCrossRefGoogle Scholar
  17. 17.
    McFarland LV, Surawicz CM, Stamm WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678–84.PubMedCrossRefGoogle Scholar
  18. 18.
    McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Wiström J, Norrby SR, Myhre EB, Eriksson S, Granström G, Lagergren L, et al. Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother 2001;47:43–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Barbut F, Corthier G, Charpak Y, Cerf M, Monteil H, Fosse T, et al. Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. A French multicenter study. Arch Intern Med 1996;156:1449–54.PubMedCrossRefGoogle Scholar
  21. 21.
    Sambol SP, Merrigan MM, Lyerly D, Gerding DN, Johnson S. Toxin gene analysis of a variant strain of Clostridium difficile that causes human clinical disease. Infect Immun 2000;68:5480–7.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Crobach MJT, Dekkers OM, Wilcox MH, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): data review and recommendations for diagnosing Clostridium difficile-infection (CDI). Clin Microbiol Infect 2009; 15:1053–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Turgeon DK, Novicki TJ, Quick J, Carlson L, Miller P, Ulness B, et al. Six rapid tests for direct detection of Clostridium difficile and its toxins in fecal samples compared with the fibroblast cytotoxicity assay. J Clin Microbiol 2003;41:667–70.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Lyerly DM, Wilkins TD. Commercial latex test for Clostridium difficile toxin A does not detect toxin A. J Clin Microbiol 1986;23:622–3.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Planche T, Aghaizu A, Holliman R, Riley P, Poloniecki J, Breathnach A, et al. Diagnosis of Clostridium difficile infection by toxin detection kits: a systematic review. Lancet Infect Dis 2008;8: 777–84.PubMedCrossRefGoogle Scholar
  26. 26.
    Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478–98.PubMedCrossRefGoogle Scholar
  27. 27.
    Suzanne J, Miguet JP, Pageaut JP, Carayon P, Pageaut G, Gisselbrecht H. Rectoscopy: a useful tool to diagnose pseudomembranous colitis (author’s transl). Nouv Presse Med 1978;7:2245–7.PubMedGoogle Scholar
  28. 28.
    Sumner HW, Tedesco FJ. Rectal biopsy in clindamycinassociated colitis. An analysis of 23 cases. Arch Pathol 1975;99: 237–41.PubMedGoogle Scholar
  29. 29.
    Cammerer RC, Anderson DL, Boyce HW Jr, Burdick GE. Clinical spectrum of pseudomembranous colitis. JAMA 1976;235: 2502–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Johal SS, Hammond J, Solomon K, James PD, Mahida YR. Clostridium difficile associated diarrhoea in hospitalised patients: onset in the community and hospital and role of flexible sigmoidoscopy. Gut 2004;53:673–7.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Gerding DN, Olson MM, Peterson LR, Teasley DG, Gebhard RL, Schwartz ML, et al. Clostridium difficile-associated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med 1986;146:95–100.PubMedCrossRefGoogle Scholar
  32. 32.
    Triadafilopoulos G, Hallstone AE. Acute abdomen as the first presentation of pseudomembranous colitis. Gastroenterology 1991;101:685–91.PubMedGoogle Scholar
  33. 33.
    Beaugerie L, Ngô Y, Goujard F, Gharakhanian S, Carbonnel F, Luboinski J, et al. Etiology and management of toxic megacolon in patients with human immunodeficiency virus infection. Gastroenterology 1994;107:858–63.PubMedCrossRefGoogle Scholar
  34. 34.
    Nomura K, Fujimoto Y, Yamashita M, Morimoto Y, Ohshiro M, Sato K, et al. Absence of pseudomembranes in Clostridium difficile-associated diarrhea in patients using immunosuppression agents. Scand J Gastroenterol 2009;44:74–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Berg AM, Kelly CP, Farraye FA. Clostridium difficile infection in the inflammatory bowel disease patient. Inflamm Bowel Dis 2013;19:194–204.PubMedCrossRefGoogle Scholar
  36. 36.
    Tedesco FJ, Barton RW, Alpers DH. Clindamycin-associated colitis. A prospective study. Ann Intern Med 1974;81:429–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Gerding DN, Brazier JS. Optimal methods for identifying Clostridium difficile infections. Clin Infect Dis 1993;16:S439–S42.PubMedCrossRefGoogle Scholar
  38. 38.
    Bergstein JM, Kramer A, Wittman DH, Aprahamian C, Quebbeman EJ. Pseudomembranous colitis: how useful is endoscopy? Surg Endosc 1990;4:217–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Burkart NE, Kwaan MR, Shepela C, Madoff RD, Wang Y, Rothenberger DA, et al. Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection. Gastroenterol Res Pract 2011;2011:626582.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Barbut F, Beaugerie L, Delas N, Fossati-Marchal S, Aygalenq P, Petit JC. Comparative value of colonic biopsy and intraluminal fluid culture for diagnosis of bacterial acute colitis in immunocompetent patients. Infectious Colitis Study Group. Clin Infect Dis 1999;29:356–60.CrossRefGoogle Scholar
  41. 41.
    Wullt M, Odenholt I, Walder M. Activity of three disinfectants and acidified nitrite against Clostridium difficile spores. Infect Control Hosp Epidemiol 2003;24:765–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Shetler K, Nieuwenhuis R, Wren SM, Triadafilopoulos G. Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis. Surg Endosc 2001;15:653–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Pasic M, Jost R, Carrel T, Von Segesser L, Turina M. Intracolonic vancomycin for pseudomembranous colitis. N Engl J Med 1993;329:583.PubMedCrossRefGoogle Scholar
  44. 44.
    McFarland LV, Surawicz CM, Greenberg RN, Fekety R, Elmer GW, Moyer KA, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA J Am Med Assoc 1994;271:1913–8.CrossRefGoogle Scholar
  45. 45.
    McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:1769–75.PubMedCrossRefGoogle Scholar
  46. 46.
    Eiseman B, Silen W, Bascom GS, Kauvar AJ. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery 1958;44:854–9.PubMedGoogle Scholar
  47. 47.
    Brandt LJ, Aroniadis OC, Mellow M, Kanatzar A, Kelly C, Park T, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol 2012;107:1079–87.PubMedCrossRefGoogle Scholar
  48. 48.
    Aas J, Gessert CE, Bakken JS. Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clin Infect Dis 2003;36:580–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  1. 1.Service de gastroentérologie et d’endoscopie digestiveCHRU J.-MinjozBesançon, ParisFrance

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