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Clostridium-difficile-assoziierte Kolitis

Teil 1: Epidemiologie, klinisches Erscheinungsbild und Diagnose

Clostridium difficile-associated colitis

Part 1: Epidemiology, clinical manifestation and diagnosis

  • CME Zertifizierte Fortbildung
  • Published:
coloproctology Aims and scope

Zusammenfassung

Das Clostridium difficile ist ein grampositives, sporenbildendes und toxinproduzierendes Bakterium. Seine Besiedelung des Gastrointestinaltrakts wird durch die Gabe verschiedener Antibiotika, insbesondere Clindamycin, Zephalosporine, Breitbandpenizilline und Fluorchinolone, begünstigt. Nur einige Infizierte erkranken. Der klinisch unauffällige Trägerstatus bei stationären Patienten beträgt 20–50%. Das klinische Erscheinungsbild reicht von symptomlos bis hin zur schwersten Verlaufsform mit toxischem Megakolon. Leitsymptom ist der wässrige Durchfall, begleitet von einer meist ausgeprägten Leukozytose. Endoskopisch bietet sich im fortgeschrittenen Stadium das Bild einer pseudomembranösen Kolitis. Es gibt verschiedene Nachweisverfahren. In der Regel wird der Erreger indirekt über den Toxinnachweis identifiziert. Standardverfahren hierfür ist heute der Enzymimmunoassay.

Abstract

Clostridium difficile is an anerobic, Gram positive, spore-forming and toxin-producing bacillus. Colonization of the intestinal tract is facilitated by the administration of several antibiotics, particularly clindamycin, broad spectrum penicillins, fluoroquinolones and cephalosporins. The cardinal clinical symptom is watery diarrhea accompanied by a pronounced leukocytosis. The clinical manifestation of a Clostridium difficile infection ranges from an asymptomatic carrier to fulminant disease with toxic megacolon. The presence of pseudomembranes during sigmoidoscopy is sufficient to make a presumptive diagnosis of Clostridium difficile infection. Laboratory tests usually use toxin assays for an indirect proof of the pathogen. The current standard approach is an enzyme immunoassay testing for the presence of Clostridium difficile toxins A and B.

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  1. Klinik für Allgemein-, Viszeral und Unfallchirurgie, Akademisches Lehrkrankenhaus, Elisabeth-Krankenhaus Essen/Contilia GmbH, Klara-Kopp-Weg 1, 45138, Essen, Deutschland

    P.M. Markus

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Markus, P. Clostridium-difficile-assoziierte Kolitis. coloproctology 34, 379–390 (2012). https://doi.org/10.1007/s00053-012-0307-3

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