RECURRENT CLOSTRIDIUM DIFFICILE INFECTION IN THE 13-YEAR OLD CHILD

In the last decade Clostridium difficile infection (CDI) has become a major cause of antibiotic-associated inflammatory lesions of the colon. Against the backdrop of the widespread increase in the frequency allocation of highly virulent strains C. difficile growing number of hard-to-therapy forms with recurrent infections. Standards of the treatment of recurrent CDI in children have not been developed. At the same time questions the effectiveness of primary and secondary prevention of CDI in recent years acute in the daily practice of pediatricians. The paper presents a clinical case of recurrent course of antibiotic-associated intestinal lesions caused by infection with C. difficile, a child of 13 years. Analysis of the case has highlighted the problems of diagnosis and treatment of recurrent CDI, the solution of which may include the following measures. When questionable results of screening to identify C. difficile toxins A and B in the feces of patients with diarrhea syndrome by enzyme immunoassay is necessary to continue studies reliable methods (isolation of toxigenic culture), that is to use multi-stage algorithms for diagnosis, as suggested by the existing recommendations. Treatment of the first episode of non-severe forms of the CDI with Metronidazole does not provide proof of clinical effect, which should be considered in practice. The results of continuous monitoring of the level of regional peculiarities C. difficile resistance to Metronidazole can help in selecting initial therapy CDI. The first CDI recurrence is more severe than the first episode, and accompanied and supported expressed by intestinal dysbiosis, demanding compensation active. The use of Vancomycin long course with a gradual reduction of the dose for the treatment of recurrent CDI does not guarantee the development of subsequent relapse, indicating that long-term maintenance of inflammatory changes in the intestinal mucosa, reduction of non-specific resistance of the organism against the backdrop of recurrent CDI and urges the need to find and use effective means of local anti-inflammatory therapy.

Clostridium difficile инфекция, Clostridium difficile infection, recurrent course, children, diagnosis, treatment, prevention

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