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Zentralbl Chir 2018; 143(03): 241-249
DOI: 10.1055/s-0043-119894
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Clostridium-difficile-Infektionen: Epidemiologie, Klinik, Therapieoptionen und Prävention

Clostridium difficile Infection: Epidemiology, Clinical Presentation, Therapy and Prevention
Magnus Kaffarnik
1   Chirurgische Klinik, Charité – Universitätsmedizin Berlin, Deutschland
,
Caroline Isner
2   Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité – Universitätsmedizin Berlin, Deutschland
,
Uwe Hamsen
3   Chirurgische Klinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
› Author Affiliations
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Publication History

Publication Date:
30 November 2017 (online)

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Zusammenfassung

Clostridium-difficile-Infektionen (CDI) gehören zu den häufigsten Ursachen einer Diarrhö bei hospitalisierten internistischen und chirurgischen Patienten. Das klinische Bild reicht von milden Durchfällen bis hin zu einer pseudomembranösen Enterokolitis des Dick- und sehr selten auch des Dünndarms mit Ausbildung eines toxischen Megakolons. Auch rezidivierende Infektionen sind nicht selten. Aufgrund der signifikanten Morbiditäts- und Mortalitätsrate der CDI steht eine frühe Diagnose der Erkrankung im Vordergrund. Es ist wichtig, die Risikofaktoren für eine CDI zu kennen. Um Komplikationen zu vermeiden, muss eine Therapie frühzeitig eingeleitet werden. Die klassische konservative Therapie ist die Gabe von Antibiotika. In Entwicklung befinden sich monoklonale Antikörper und eine Clostridium-difficile-Vakzine. Bei fulminanten, septischen Verläufen ist häufig eine operative Fokussanierung indiziert. Durch minimalinvasive Operationstechniken sollte die Möglichkeit einer frühzeitigen operativen Therapie mittels doppelläufigem Ileostoma und antibiotischen Einläufen erwogen werden. Eine neue Therapiestrategie bei Infektrezidiven ist die Stuhlübertragung. Präventions- und Kontrollmaßnahmen sind wichtig, um eine Verbreitung des Erregers zu vermeiden. Dazu gehören die Isolierung von Clostridium-difficile-Patienten, die Personalisierung von Instrumenten, die Begrenzung von Patiententransporten auf notwendige Fälle, Tragen von Einmalkitteln und -handschuhen, die strenge Einhaltung der Handhygiene und das Antibiotic Stewardship (ABS).

Abstract

Clostridium difficile infections (CDI) are common causes of diarrhoea in hospitalised medical and surgical patients. Clinical presentation ranges from mild diarrhoea to pseudomembraneous enterocolitis of the colon and sometimes the small intestines, with development of a toxic megacolon. Recurrent infections are common. Early diagnosis is necessary because of high rates of complications and mortality. Knowledge of risk factors for the development of CDI is recommended. Early initiation of therapy is recommended to avoid complications and standard therapy is antibiotics, while therapy with monoclonal antibodies and vaccination is under research and development. Fulminant septic courses indicate surgical source control. Minimally invasive surgical therapy establishing a loop ileostomy and antibiotic installation via enema has to be considered as early surgical intervention. Fecal microbiotic transplantation is a new therapeutic option for recurrent infection. Provisions for prevention and control have to be established to avoid in-hospital spread of pathogenic agents. This includes isolation of patients, personalisation of instruments, restriction of in-hospital transports, protective clothing and gloves, strict hand washing and antibiotic stewardship (ABS).

Schlüsselwörter

Clostridium difficile - toxisches Megakolon - Stuhlübertragung - Mikrobiomtransfer

Key words

Clostridium difficile - toxic megacolon - stool transplantation - microbiom transfer
 

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