• MeSH
• Clostridioides difficile * účinky léků   MeSH
• dítě MeSH
• fidaxomicin * farmakologie   terapeutické užití   MeSH
• klostridiové infekce * farmakoterapie   MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

• Klíčová slova
• fidaxomicin Dificlir,
• MeSH
• aminoglykosidy * aplikace a dávkování   ekonomika   farmakologie   škodlivé účinky   terapeutické užití   MeSH
• antibakteriální látky * MeSH
• Clostridioides difficile * klasifikace   patogenita   účinky léků   MeSH
• infekce spojené se zdravotní péčí farmakoterapie   prevence a kontrola   přenos   MeSH
• kolitida MeSH
• lékové interakce MeSH
• lidé MeSH
• makrolidy MeSH
• nežádoucí účinky léčiv MeSH
• pediatrie normy   MeSH
• průjem MeSH
• recidiva MeSH
• senioři MeSH
• těhotenství MeSH
• výroba orphan drugs normy   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• těhotenství MeSH

OBJECTIVE: Clostridium difficile infection (CDI) has become one of the most common causes of hospital-acquired infections. Fidaxomicin is one of the latest antibiotics used in the treatment of CDI, however, treatment cost affects recommendations for its use in several countries. We have analysed the treatment of our patients with CDI, treated by fidaxomicin since it was introduced to the market in 2018 and became available in the second biggest Slovak hospital, University Hospital of L. Pasteur. Our aim was to determine efficacy and safety of fidaxomicin in the treatment of CDI in Slovak patients. METHODS: We reviewed all courses of fidaxomicin use in our hospital (n = 60). Fidaxomicin was used for first recurrence (12 times), second recurrence (4 times), third recurrence (2 times), and fifth recurrence (1 patient). 41 patients received fidaxomicin first-line. RESULTS: Success of fidaxomicin treatment was recorded at 86.7% within the whole cohort. In the recurrent Clostridium difficile infection (rCDI) subgroup, fidaxomicin was 63% effective with three patients dying (15.7%) and two patients developing subsequent rCDI. During the duration of the study, 6 patients in total died. Only one of three patients, with three or more recurrences of CDI, had no further presentations after eight weeks of completion of treatment. CONCLUSIONS: The biggest benefit from fidaxomicin treatment was shown in a cohort of patients with primary CDI infection demonstrating a low recurrence rate and significant reduction of fidaxomicin effectiveness in preventing a recurrence when treating patients with multiple rCDI.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• Clostridioides difficile účinky léků   izolace a purifikace   MeSH
• dítě MeSH
• dospělí MeSH
• fidaxomicin terapeutické užití   MeSH
• klostridiové infekce diagnóza   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH

PURPOSE: We aimed to evaluate the efficacy of different antibiotic regimens for the treatment of Clostridioides difficile infection (CDI) with regard to the CDI episode number and disease severity. METHODS: An observation cohort study included 271 CDI patients hospitalised between 2013-2016. Univariate logistic regression was used to evaluate the association between patients' clinical outcome (sustained clinical cure or recurrence) in a 60-day follow-up and the antibiotic regimen used (oral metronidazole, oral vancomycin, combination of oral vancomycin and metronidazole, oral fidaxomicin). Subgroup analyses, based on CDI episode number and severity, were performed. RESULTS: In the overall population, fidaxomicin was superior to metronidazole, vancomycin or their combination, for a sustained clinical response and in the prevention of recurrent CDI (rCDI). In the subgroup analyses, fidaxomicin was superior to vancomycin or metronidazole for a sustained clinical response and in the prevention of rCDI in the initial episode, first recurrence and non-severe cases. In the oral treatment of severe CDI, fidaxomicin had a similar treatment outcome to vancomycin and none of the antibiotic treatments were superior in the prevention of rCDI. Fidaxomicin, vancomycin, or a combination of metronidazole and vancomycin, had similar outcomes for sustained clinical response and prevention of rCDI in patients with multiple rCDI. CONCLUSION: Fidaxomicin was superior to metronidazole or vancomycin for the treatment of the initial episode, first recurrence, and non-severe CDI.

• MeSH
• antibakteriální látky farmakologie   MeSH
• aplikace orální MeSH
• Clostridioides difficile účinky léků   MeSH
• fidaxomicin farmakologie   MeSH
• hospitalizace MeSH
• klostridiové infekce farmakoterapie   mikrobiologie   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• metronidazol farmakologie   MeSH
• recidiva MeSH
• senioři MeSH
• vankomycin farmakologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Recently, the recommendations for the treatment of Clostridioides difficile infection (CDI) have been updated. However, in addition to the clinical efficacy data, the drug of choice should ideally represent optimal antimicrobial stewardship, with an emphasis on rapid restoration of the gut microbiota to minimize the risk of infection relapses. Oral administration of metronidazole results in low concentration in stool, and interaction with fecal microbiota reduces its antimicrobial bioactivity. Reported elevated minimum inhibitory concentrations of metronidazole in epidemic C. difficile ribotypes and the emergence of plasmid-mediated resistance to metronidazole represent additional potential risks for clinical failure. If metronidazole is the only CDI treatment option, antimicrobial susceptibility testing on agar containing heme should be performed in C. difficile isolate. Compared with metronidazole, oral vancomycin and fidaxomicin reach very high concentrations in the stool, and therefore can quickly reduce C. difficile shedding. Health care facilities with higher CDI incidence and/or occurrence of epidemic ribotypes should not use metronidazole because prolonged C. difficile shedding can increase the risk for further C. difficile transmission. Only fidaxomicin has a narrow spectrum of antimicrobial activity, which might be, together with persistence on spores, the main contributing factor to reduce the recurrent CDI rates.

• MeSH
• antibakteriální látky farmakologie   terapeutické užití   MeSH
• Clostridioides difficile * MeSH
• fidaxomicin terapeutické užití   MeSH
• klostridiové infekce * farmakoterapie   epidemiologie   mikrobiologie   MeSH
• lidé MeSH
• metronidazol farmakologie   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Cíl práce: Clostridium difficile (C. difficile) sehrává okrajovou, ale významnou úlohu v pediatrii. Cílem práce je objektivizace dat a jejich význam v klinické praxi, sdělit naše zkušenosti s léčbou pediatrických pacientů. Materiál a metodika: Sběr dat probíhal retrospektivně u pacientů (0–19 let) z pětiletého období 2013–2017 hospitalizovaných s diagnózou klostridiová kolitida na Klinice dětských infekčních nemocí (KDIN) FN Brno. Každý pacient byl testován dvoustupňovým diagnostickým algoritmem metodou imunochromatografického testu a polymerázové řetězové reakce (PCR). Výsledky: 35 pacientů s mediánovým věkem 10,3 roků (1–17,5 roku) bylo zapsáno do studie. Věková skupina 6–19 let tvořila dohromady téměř 70 %. U jednoho pacienta nebyl odhalen žádný rizikový faktor, 41,6 % případů tvořili pacienti s onkologickou diagnózou a nespecifickými střevními záněty, ve 2,5 % syndrom krátkého střeva. Mediánová doba ústupu průjmů byla 2,5 dne po cílené léčbě na klostridiovou kolitidu. Ve více jak polovině případů byl použit metronidazol. V 5 případech byl podáván fidaxomicin s dobrou tolerancí. Ve 3 případech došlo k selhání terapie po metronidazolu. K rekurenci po nedokončené léčbě došlo v jednom případě. V 86 % případů se jednalo o klostridiovou kolitidu spojenou se zdravotní péčí. Více atak kolitidy bylo zaznamenáno u čtyř dětí (2krát malignita, 1krát nespecifický střevní zánět, 1krát syndrom krátkého střeva). Závěr: Průběh klostridiové kolitidy je obecně v pediatrické populaci mírný, bez rizikového faktoru je vzácná. Pediatričtí pacienti dobře odpovídají na léčbu metronidazolem. Fidaxomicin byl úspěšně tolerován ve všech případech. U vysoce rizikových skupin (imunosuprese, syndrom krátkého střeva, nespecifický střevní zánět) preferujeme primárně léčbu fidaxomicinem.

Aims: Clostridium difficile (C. difficile) plays a minor but important role in paediatrics. The aims of this study were to objectivise data, to show their significance in clinical practice, and to present our experience with the treatment of paediatric patients. Materials and methods: A retrospective study was conducted in patients (0–19 years of age) hospitalized for Clostridium difficile infection (CDI) in the Department of Paediatric Infectious Diseases, University Hospital in Brno between 2013 and 2017. Each patient was tested using a two-step diagnostic screening algorithm including immunochromatography and polymerase chain reaction assays. Results: Thirty-five patients with a median age of 10.3 years (range 1–17.5 years) were enrolled in the study. Almost 70% of patients were aged between 6 and 19 years. No risk factor was identified in one patient, 41.6% of cases were patients with malignancy or inflammatory bowel disease, and 2.5% of patients had short bowel syndrome. After targeted CDI treatment, the median time to resolution of diarrhoea was 2.5 days. Metronidazole was used in more than half of cases. Five patients received fidaxomicin, which was well tolerated. Metronidazole failed in three cases. Recurrence after incomplete treatment with metronidazole occurred in one patient. Health care-associated CDI was recorded in 86% of cases. Recurrent CDI was reported in four children (two with malignancy, one with inflammatory bowel dissease, and one with short bowel syndrome). Conclusions: The course of CDI is generally mild in the paediatric population. CDI without a risk factor is rare. Paediatric patients respond well to metronidazole. Fidaxomicin was well tolerated by all patients. We prefer the treatment with fidaxomicin in high-risk groups (immunocompromised condition, inflammatory bowel disease, and short bowel syndrome).

• Klíčová slova
• klostridiová kolitida,
• MeSH
• Clostridioides difficile MeSH
• dítě MeSH
• fidaxomicin terapeutické užití   MeSH
• infekce spojené se zdravotní péčí MeSH
• klostridiové infekce * epidemiologie   mikrobiologie   terapie   MeSH
• kojenec MeSH
• lidé MeSH
• metronidazol terapeutické užití   MeSH
• mladiství MeSH
• předškolní dítě MeSH
• průjem farmakoterapie   MeSH
• retrospektivní studie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH

BACKGROUND: Clostridioides difficile infections (CDI) are traditionally attributed to an older adult patient group but children can also be affected. Although the causative pathogen is the same in both populations, the management of CDI may differ. OBJECTIVES: To discuss the current literature on CDI in the paediatric population and to provide CDI diagnostics and treatment guidance. SOURCES: The literature was drawn from a search of PubMed from January 2017 to July 2021. CONTENT: In the paediatric population, laboratory diagnostics for CDI should preferably be combined with laboratory diagnostics for other gastrointestinal pathogens. Coinfections of CDI are also possible. Though the detection of toxigenic C. difficile using a molecular assay may simply reflect colonisation rather than infection, detection of C. difficile free toxins A/B in faeces is much more indicative of true infection. CDI in children below 2 years of age and in the absence of risk factors is very difficult to diagnose and requires careful clinical judgement pending additional studies. Fidaxomicin has been shown to be superior to vancomycin with a sustained clinical response up to 30 days after the end of CDI treatment in children. Metronidazole is less effective than vancomycin in adults and there are no supporting data for its use in children. In recurrent CDI, treatment should be adjusted according to the drug or drug regimen used for the treatment of a previous episode(s). In multiple recurrent CDI, faecal microbiota transplantation can be effective. IMPLICATIONS: If CDI laboratory testing is indicated in children with diarrhoea, the likelihood of C. difficile colonisation and coinfection with other intestinal pathogens should be considered. The currently available data support a change in the treatment strategy of CDI in children.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• Clostridioides difficile * MeSH
• dítě MeSH
• fidaxomicin terapeutické užití   MeSH
• klostridiové infekce * diagnóza   epidemiologie   terapie   MeSH
• lidé MeSH
• senioři MeSH
• vankomycin terapeutické užití   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• aminoglykosidy * aplikace a dávkování   kontraindikace   terapeutické užití   MeSH
• antibakteriální látky * aplikace a dávkování   kontraindikace   terapeutické užití   MeSH
• Clostridioides difficile * patogenita   účinky léků   MeSH
• fidaxomicin MeSH
• klostridiové infekce farmakoterapie   komplikace   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

SCOPE: In 2009, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) published the first treatment guidance document for Clostridioides difficile infection (CDI). This document was updated in 2014. The growing literature on CDI antimicrobial treatment and novel treatment approaches, such as faecal microbiota transplantation (FMT) and toxin-binding monoclonal antibodies, prompted the ESCMID study group on C. difficile (ESGCD) to update the 2014 treatment guidance document for CDI in adults. METHODS AND QUESTIONS: Key questions on CDI treatment were formulated by the guideline committee and included: What is the best treatment for initial, severe, severe-complicated, refractory, recurrent and multiple recurrent CDI? What is the best treatment when no oral therapy is possible? Can prognostic factors identify patients at risk for severe and recurrent CDI and is there a place for CDI prophylaxis? Outcome measures for treatment strategy were: clinical cure, recurrence and sustained cure. For studies on surgical interventions and severe-complicated CDI the outcome was mortality. Appraisal of available literature and drafting of recommendations was performed by the guideline drafting group. The total body of evidence for the recommendations on CDI treatment consists of the literature described in the previous guidelines, supplemented with a systematic literature search on randomized clinical trials and observational studies from 2012 and onwards. The Grades of Recommendation Assessment, Development and Evaluation (GRADE) system was used to grade the strength of our recommendations and the quality of the evidence. The guideline committee was invited to comment on the recommendations. The guideline draft was sent to external experts and a patients' representative for review. Full ESCMID endorsement was obtained after a public consultation procedure. RECOMMENDATIONS: Important changes compared with previous guideline include but are not limited to: metronidazole is no longer recommended for treatment of CDI when fidaxomicin or vancomycin are available, fidaxomicin is the preferred agent for treatment of initial CDI and the first recurrence of CDI when available and feasible, FMT or bezlotoxumab in addition to standard of care antibiotics (SoC) are preferred for treatment of a second or further recurrence of CDI, bezlotoxumab in addition to SoC is recommended for the first recurrence of CDI when fidaxomicin was used to manage the initial CDI episode, and bezlotoxumab is considered as an ancillary treatment to vancomycin for a CDI episode with high risk of recurrence when fidaxomicin is not available. Contrary to the previous guideline, in the current guideline emphasis is placed on risk for recurrence as a factor that determines treatment strategy for the individual patient, rather than the disease severity.

• MeSH
• antibakteriální látky * terapeutické užití   MeSH
• Clostridioides difficile MeSH
• dospělí MeSH
• fidaxomicin MeSH
• klostridiové infekce * diagnóza   farmakoterapie   MeSH
• lidé MeSH
• monoklonální protilátky MeSH
• recidiva MeSH
• široce neutralizující protilátky MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• společnosti lékařské MeSH
• vankomycin MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Průjmovité infekce asociované s Clostridium difficile a pseudomembranózní kolitida představují závažnou výzvu současné klinické praxe a jsou rizikem pro každého pacienta léčeného širokospektrými antibiotiky jak v nemocničním, tak ambulantním prostředí. I když klostridiová enterokolitida zůstává zatím relativně stranou pozornosti laické veřejnosti, počet pacientů ohrožených tímto onemocněním neustále narůstá. Recentní léčebné postupy zdůrazňují snahu o zachování fyziologické střevní flóry při současné optimalizaci imunitní odpovědi hostitele. Následující článek prezentuje přehled aktuálních léčebných strategií se zvláštním důrazem na recidivující formu onemocnění.

Clostridium difficile-associated diarrhea (CDAD) and pseudomembranous colitis have become a significant challenge in current clinical medicine, posing a serious risk to any patient undergoing treatment with broad-spectrum antibiotics in either inpatient and outpatient setting. Although CDAD still remains relatively unknown to the lay public, the number of patients at risk of developing this condition is growing steadily. Recent treatment approaches seek to maintain normal colonic flora while effectively optimizing host immune response. The following article presents a concise overview of up-to-date guidelines with particular emphasize on recurrent form of the disease. fidaxomicin, fecal transplantation, vaccination.

• Klíčová slova
• klostridiová enterokolitida, pseudomembranózní kolitida, širokospektrá antibiotika, transplantace stolice, očkování,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• bakteriologické techniky metody   MeSH
• Clostridioides difficile * izolace a purifikace   patogenita   účinky léků   MeSH
• diagnostické techniky molekulární metody   MeSH
• enterokolitida * epidemiologie   mikrobiologie   MeSH
• fidaxomicin MeSH
• klostridiové infekce * diagnóza   farmakoterapie   MeSH
• lidé MeSH
• metronidazol * aplikace a dávkování   MeSH
• probiotika terapeutické užití   MeSH
• pseudomembranózní enterokolitida * epidemiologie   mikrobiologie   MeSH
• recidiva prevence a kontrola   MeSH
• rizikové faktory MeSH
• vankomycin * aplikace a dávkování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH