Antibioticoterapia y nuevas terapias no farmacológicas en infecciones por Clostridium difficile
Palabras clave:
Clostridium difficile, infección por Clostridium difficile, colitis pseudomembranosa. Fuente: MeSH
Resumen
La infección por Clostridium difficile es la principal causa de diarrea infecciosa en pacientes hospitalizados. Los pacientes pueden ser portadores asintomáticos o presentar desde una diarrea leve a una colitis pseudomembranosa, megacolon tóxico, sepsis y muerte. El manejo de esta infección sigue presentando puntos de controversia, tanto en la elección del mejor método diagnóstico como en el tratamiento. En los casos en los cuales la infección por este agente fue confirmada la primera y más efectiva medida es suspender la antibioticoterapia que el paciente este recibiendo, en la medida de lo posible. El tratamiento se basa en tres agentes clásicos: metronidazol, vancomicina y teicoplanina con la más reciente adición de fidaxomicina y ridinilazol. Pacientes con presentación severa muchas veces requieren resolución quirúrgica además de las medidas de soporte y monitoreo. El objetivo de esta revisión es ofrecer información actualizada sobre la patogénesis y estrategias terapéuticas sobre el manejo de la infección por este patógeno.
Citas
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[5] L. Meyer, R. Espinoza, and R. Quera, “Infección por Clostridium difficile: Epidemiología, Diagnóstico y Estrategias Terapéuticas,” Rev. Med. Clin. Condes, vol. 25, no. 3, pp. 473–484, 2014.
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[9] E. B. Chahine and A. J. Sucher, “An Update on Clostridium difficile Infection and its Management,” Drug Topics, vol. 154, no. 12, pp. 30–41, 2010.
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[12] S. H. Cohen, D. N. Gerding, S. Johnson, C. P. Kelly, V. G. Loo, L. C. McDonald, J. Pepin, and M. H. Wilcox, “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., vol. 31, no. 5, pp. 431–455, 2010.
[13] D. K. C. Lamp, C. D. Freeman, N. E. Klutman, and M. K. Lacy, “Pharmacokinetics and Pharmacodynamics of the Nitroimidazole Antimicrobials,” Clin. Pharmacokinet., vol. 36, no. 5, pp. 353–373, 1999.
[14] S. Löfmark, C. Edlund, and C. E. Nord, “Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections,” Clin. Infect. Dis., vol. 50, no. s1, pp. S16–S23, 2010.
[15] C. R. Musgrave, P. B. Bookstaver, S. S. Sutton, and A. D. Miller, “Use of alternative or adjuvant pharmacologic treatment strategies in the prevention and treatment of Clostridium difficile infection,” Int. J. Infect. Dis., vol. 15, no. 7, pp. e438–e448, 2011.
[16] L. C. Pineda and K. M. Watt, “New Antibiotic Dosing in Infants,” Clin. Perinatol., vol. 42, no. 1, pp. 167–176, 2014.
[17] M. M. Soriano and S. Johnson, “Treatment of Clostridium difficile Infections,” Infect. Dis. Clin. North Am., vol. 29, no. 1, pp. 93–108, 2015.
[18] M. J. Rybak, “The pharmacokinetic and pharmacodynamic properties of vancomycin.,” Clin. Infect. Dis., vol. 42 Suppl 1, no. Suppl 1, pp. S35–S39, 2006.
[19] C. Vaishnavi, “Fidaxomicin - the new drug for Clostridium difficile infection,” Indian J Med Res, vol. 141, no. April, pp. 398–407, 2015.
[20] G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, and A. Fidaxomicin, “Fidaxomicin : A novel agent for the treatment of Clostridium difficile infection,” Can J Infect Dis Med Microbiol, vol. 26, no. 6, pp. 305–312, 2015.
[21] T. Crawford, E. Huesgen, and L. Danziger, “Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection,” Am. J. Heal. Pharm., vol. 69, no. 6, pp. 933–943, 2012.
[22] O. A. Cornely, D. Nathwani, C. Ivanescu, O. Odufowora-Sita, P. Retsa, and I. A. O. Odeyemi, “Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison,” J. Antimicrob. Chemother., vol. 69, no. 11, pp. 2892–2900, 2014.
[23] S. Curry, “Clostridium difficile.,” Clin. Lab. Med., vol. 30, no. 1, pp. 329–42, 2010. [24] K. Z. Vardakas, K. a. Polyzos, K. Patouni, P. I. Rafailidis, G. Samonis, and M. E. Falagas, “Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: A systematic review of the evidence,” Int. J. Antimicrob. Agents, vol. 40, no. 1, pp. 1–8, 2012.
[25] M. Drekonja, M. Butler, R. MacDonald, D. Bliss, G. A. Filice, T. S. Rector, and T. J. Wilt, “Comparative Effectiveness of Clostridium difficile Treatments,” Ann. Intern. Med., vol. 155, no. 12, pp. 839–847, 2011.
[26] R. Li, L. Lu, Y. Lin, M. Wang, and X. Liu, “Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or Combination Therapy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis,” PLoS One, vol. 10, no. 10, 2015.
[27] X. Di, N. Bai, X. Zhang, B. Liu, W. Ni, J. Wang, K. Wang, B. Liang, Y. Liu, and R. Wang, “A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity.,” Brazilian J. Infect. Dis., vol. 19, no. 4, pp. 339–349, 2015.
[28] K. B. To and L. M. Napolitano, “Clostridium difficile Infection: Update on Diagnosis, Epidemiology, and Treatment Strategies,” Surg. Infect. (Larchmt)., vol. 15, no. 5, pp. 490–502, 2014.
[29] A. a. Venugopal and S. Johnson, “Current state of clostridium difficile treatment options,” Clin. Infect. Dis., vol. 55, no. SUPPL.2, pp. 71–76, 2012.
[30] H. Mathur, M. C. Rea, P. D. Cotter, R. Paul Ross, and C. Hill, “The potential for emerging therapeutic options for Clostridium difficile infection.,” Gut Microbes, vol. 5, no. 6, pp. 696–710, 2014.
[31] E. J. Goldberg, S. Bhalodia, S. Jacob, H. Patel, K. V. Trinh, B. Varghese, J. Yang, S. R. Young, and R. B. Raffa, “Clostridium difficile infection: A brief update on emerging therapies,” Am. J. Heal. Pharm., vol. 72, no. 12, pp. 1007–1012, 2015.
[32] E. Gough, H. Shaikh, and A. R. Manges, “Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection,” Clin. Infect. Dis., vol. 53, no. 10, pp. 994–1002, 2011.
[33] Y.-T. Li, H.-F. Cai, Z.-H. Wang, J. Xu, and J.-Y. Fang, “Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection,” Aliment Pharmacol Ther, vol. 43, pp. 445–457, 2016.
[34] D. Drekonja, J. Reich, S. Gezahegn, N. Greer, A. Shaukat, R. MacDonald, I. Rutks, and T. J. Wilt, “Fecal Microbiota Transplantation for Clostridium difficile Infection,” Ann. Intern. Med., vol. 162, no. 9, p. 630, 2015.
[35] I. L. Scully, K. Swanson, L. Green, K. U. Jansen, and A. S. Anderson, “Anti-infective vaccination in the 21st century-new horizons for personal and public health,” Curr. Opin. Microbiol., vol. 27, pp. 96–102, 2015.
[36] A. Le Monnier, J. R. Zahar, and F. Barbut, “Update on Clostridium difficile infections,” Med. Mal. Infect., vol. 44, no. 8, pp. 354–365, 2014.
[37] R.vichers, G.Tillotson, E.Goldstein, D. Citron, K. Garey, M. Wilcox, “Ridinilazole: a novel therapy for Clostridium difficile infection”, International Journal of Antimicrobial Agents, no 48, pp.137-143, 2016.
[2] V. Loo, L. Poirier, M. Miller, M. Oughton, M. Libman, S. Michaud, A. M. Bourgault, T. Nguyen, C. Frenette, M. Kelly, A. Vibien, P. Brassard, S. Fenn, K. Dewar, T. Hudson, R. Horn, P. René, Y. Monczak, and A. Dascal, “A Predominantly Clonal Multi-Institutional Outbreak of,” N. Engl. J. Med., vol. 353, no. 23, pp. 2442–9, 2005.
[3] C. Quesada-Gómez, C. Rodríguez, M. Gamboa-Coronado, E. Rodríguez-Cavallini, T. Du, M. Mulvey, M. Villalobos-Zúñiga, and R. Boza-Cordero, “Emergence of Clostridium difficile NAP1 in Latin America,” J. Clin. Microbiol., vol. 48, no. 2, pp. 669–670, 2010.
[4] V.-Z. Manuel Antonio and B.-C. Ricardo, “Caracterización epidemiológica, clínica y microbiológica del brote de diarrea asociado a Clostridium difficile, ocurrido en el Hospital San Juan de Dios, 2008-2009,” Acta méd. costarric, vol. 54, no. 3, pp. 152–158, 2012.
[5] L. Meyer, R. Espinoza, and R. Quera, “Infección por Clostridium difficile: Epidemiología, Diagnóstico y Estrategias Terapéuticas,” Rev. Med. Clin. Condes, vol. 25, no. 3, pp. 473–484, 2014.
[6] F. Y. Khan and A.-N. Elzouki, “Clostridium difficile infection: a review of the literature.,” Asian Pac. J. Trop. Med., vol. 7S1, no. Suppl 1, pp. S6–S13, 2014.
[7] K. C. Carroll and J. G. Bartlett, “Biology of Clostridium difficile: implications for epidemiology and diagnosis.,” Annu. Rev. Microbiol., vol. 65, pp. 501–21, 2011.
[8] C. Frädrich, L.-A. Beer, and R. Gerhard, “Reactive Oxygen Species as Additional Determinants for Cytotoxicity of Clostridium difficile Toxins A and B,” Toxins (Basel)., vol. 8, no. 25, 2016.
[9] E. B. Chahine and A. J. Sucher, “An Update on Clostridium difficile Infection and its Management,” Drug Topics, vol. 154, no. 12, pp. 30–41, 2010.
[10] C. Vaishnavi, “Clostridium difficile infection: clinical spectrum and approach to management.,” Indian J. Gastroenterol., vol. 30, no. 6, pp. 245–54, 2011.
[11] B. Faris, a Blackmore, and N. Haboubi, “Review of medical and surgical management of Clostridium difficile infection.,” Tech. Coloproctol., vol. 14, no. 2, pp. 97–105, 2010.
[12] S. H. Cohen, D. N. Gerding, S. Johnson, C. P. Kelly, V. G. Loo, L. C. McDonald, J. Pepin, and M. H. Wilcox, “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., vol. 31, no. 5, pp. 431–455, 2010.
[13] D. K. C. Lamp, C. D. Freeman, N. E. Klutman, and M. K. Lacy, “Pharmacokinetics and Pharmacodynamics of the Nitroimidazole Antimicrobials,” Clin. Pharmacokinet., vol. 36, no. 5, pp. 353–373, 1999.
[14] S. Löfmark, C. Edlund, and C. E. Nord, “Metronidazole Is Still the Drug of Choice for Treatment of Anaerobic Infections,” Clin. Infect. Dis., vol. 50, no. s1, pp. S16–S23, 2010.
[15] C. R. Musgrave, P. B. Bookstaver, S. S. Sutton, and A. D. Miller, “Use of alternative or adjuvant pharmacologic treatment strategies in the prevention and treatment of Clostridium difficile infection,” Int. J. Infect. Dis., vol. 15, no. 7, pp. e438–e448, 2011.
[16] L. C. Pineda and K. M. Watt, “New Antibiotic Dosing in Infants,” Clin. Perinatol., vol. 42, no. 1, pp. 167–176, 2014.
[17] M. M. Soriano and S. Johnson, “Treatment of Clostridium difficile Infections,” Infect. Dis. Clin. North Am., vol. 29, no. 1, pp. 93–108, 2015.
[18] M. J. Rybak, “The pharmacokinetic and pharmacodynamic properties of vancomycin.,” Clin. Infect. Dis., vol. 42 Suppl 1, no. Suppl 1, pp. S35–S39, 2006.
[19] C. Vaishnavi, “Fidaxomicin - the new drug for Clostridium difficile infection,” Indian J Med Res, vol. 141, no. April, pp. 398–407, 2015.
[20] G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, G. G. Zhanel, A. J. Walkty, J. A. Karlowsky, and A. Fidaxomicin, “Fidaxomicin : A novel agent for the treatment of Clostridium difficile infection,” Can J Infect Dis Med Microbiol, vol. 26, no. 6, pp. 305–312, 2015.
[21] T. Crawford, E. Huesgen, and L. Danziger, “Fidaxomicin: a novel macrocyclic antibiotic approved for treatment of Clostridium difficile infection,” Am. J. Heal. Pharm., vol. 69, no. 6, pp. 933–943, 2012.
[22] O. A. Cornely, D. Nathwani, C. Ivanescu, O. Odufowora-Sita, P. Retsa, and I. A. O. Odeyemi, “Clinical efficacy of fidaxomicin compared with vancomycin and metronidazole in Clostridium difficile infections: a meta-analysis and indirect treatment comparison,” J. Antimicrob. Chemother., vol. 69, no. 11, pp. 2892–2900, 2014.
[23] S. Curry, “Clostridium difficile.,” Clin. Lab. Med., vol. 30, no. 1, pp. 329–42, 2010. [24] K. Z. Vardakas, K. a. Polyzos, K. Patouni, P. I. Rafailidis, G. Samonis, and M. E. Falagas, “Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: A systematic review of the evidence,” Int. J. Antimicrob. Agents, vol. 40, no. 1, pp. 1–8, 2012.
[25] M. Drekonja, M. Butler, R. MacDonald, D. Bliss, G. A. Filice, T. S. Rector, and T. J. Wilt, “Comparative Effectiveness of Clostridium difficile Treatments,” Ann. Intern. Med., vol. 155, no. 12, pp. 839–847, 2011.
[26] R. Li, L. Lu, Y. Lin, M. Wang, and X. Liu, “Efficacy and Safety of Metronidazole Monotherapy versus Vancomycin Monotherapy or Combination Therapy in Patients with Clostridium difficile Infection: A Systematic Review and Meta-Analysis,” PLoS One, vol. 10, no. 10, 2015.
[27] X. Di, N. Bai, X. Zhang, B. Liu, W. Ni, J. Wang, K. Wang, B. Liang, Y. Liu, and R. Wang, “A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity.,” Brazilian J. Infect. Dis., vol. 19, no. 4, pp. 339–349, 2015.
[28] K. B. To and L. M. Napolitano, “Clostridium difficile Infection: Update on Diagnosis, Epidemiology, and Treatment Strategies,” Surg. Infect. (Larchmt)., vol. 15, no. 5, pp. 490–502, 2014.
[29] A. a. Venugopal and S. Johnson, “Current state of clostridium difficile treatment options,” Clin. Infect. Dis., vol. 55, no. SUPPL.2, pp. 71–76, 2012.
[30] H. Mathur, M. C. Rea, P. D. Cotter, R. Paul Ross, and C. Hill, “The potential for emerging therapeutic options for Clostridium difficile infection.,” Gut Microbes, vol. 5, no. 6, pp. 696–710, 2014.
[31] E. J. Goldberg, S. Bhalodia, S. Jacob, H. Patel, K. V. Trinh, B. Varghese, J. Yang, S. R. Young, and R. B. Raffa, “Clostridium difficile infection: A brief update on emerging therapies,” Am. J. Heal. Pharm., vol. 72, no. 12, pp. 1007–1012, 2015.
[32] E. Gough, H. Shaikh, and A. R. Manges, “Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection,” Clin. Infect. Dis., vol. 53, no. 10, pp. 994–1002, 2011.
[33] Y.-T. Li, H.-F. Cai, Z.-H. Wang, J. Xu, and J.-Y. Fang, “Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection,” Aliment Pharmacol Ther, vol. 43, pp. 445–457, 2016.
[34] D. Drekonja, J. Reich, S. Gezahegn, N. Greer, A. Shaukat, R. MacDonald, I. Rutks, and T. J. Wilt, “Fecal Microbiota Transplantation for Clostridium difficile Infection,” Ann. Intern. Med., vol. 162, no. 9, p. 630, 2015.
[35] I. L. Scully, K. Swanson, L. Green, K. U. Jansen, and A. S. Anderson, “Anti-infective vaccination in the 21st century-new horizons for personal and public health,” Curr. Opin. Microbiol., vol. 27, pp. 96–102, 2015.
[36] A. Le Monnier, J. R. Zahar, and F. Barbut, “Update on Clostridium difficile infections,” Med. Mal. Infect., vol. 44, no. 8, pp. 354–365, 2014.
[37] R.vichers, G.Tillotson, E.Goldstein, D. Citron, K. Garey, M. Wilcox, “Ridinilazole: a novel therapy for Clostridium difficile infection”, International Journal of Antimicrobial Agents, no 48, pp.137-143, 2016.
Publicado
2020-11-13
Cómo citar
Barrientos Jiménez, M., Esquivel Zúñiga, M. R., Álvarez Umaña, S. V., Tencio Araya, J., & Soto Cerdas, J. (2020). Antibioticoterapia y nuevas terapias no farmacológicas en infecciones por Clostridium difficile. Medicina Legal De Costa Rica, 34(1). Recuperado a partir de //www.binasss.sa.cr/ojssalud/index.php/mlcr/article/view/52
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