Aktuelle Konzepte zur Diagnostik und Therapie der Clostridioides [Clostridium]-difficile-Infektion bei Patienten mit chronisch-entzündlichen Darmerkrankungen

Zusammenfassung

Patienten mit chronisch-entzündlichen Darmerkrankungen (CED) haben ein deutlich erhöhtes Risiko für Clostridioides [Clostridium] difficile Infektionen (CDI). Eine CDI kann ihrerseits die Aktivität der luminalen Entzündung erhöhen. Daher ist eine rasche Diagnostik und Therapie erforderlich. Viele Diagnose- und Behandlungsstudien zu Patienten mit CDI ohne entzündliche Darmerkrankung lassen sich nicht deckungsgleich auf CED-Patienten übertragen. Diese Übersicht fasst deshalb die alltagsrelevanten Daten der letzten Jahre zusammen und kondensiert diese in vier Leitsätzen. 1) Eine CDI verschlechtert nicht nur kurzfristig die Krankheitsaktivität, sondern bedingt langfristig eine erhöhte Morbidität (z. B. Kolektomiegefahr) und Mortalität. 2) Bei Verdacht auf eine CDI sollte rasch ein Glutamat-Dehydrogenase (GDH)-Nachweis geführt werden. Ist dieser positiv und ist die Krankheitsaktivität hoch, ist eine Therapie gegen C. diff. einzuleiten und diese ggf. bei negativen Bestätigungstests zu beenden. 3) CED-Patienten mit einer nachgewiesenen CDI sollten primär mit Vancomycin behandelt werden. 4) Bei einer rezidivierenden CDI bei Patienten mit CED ist der fäkale Mikrobiomtransfer eine effektive Therapiemaßnahme. Allerdings muss in ca. 15 % der Fälle mit einer Aktivierung der CED gerechnet werden. Ein konsequentes Beachten dieser Leitsätze kann im Umgang mit einer CDI bei CED-Patienten helfen.

Abstract

Patients with chronic inflammatory bowel disease (IBD) have a significantly increased risk of clinically relevant clostridial infection (CDI). In turn, CDI can increase IBD activity. Therefore, rapid diagnosis and therapy is required. Many diagnostic and treatment studies on patients with CDI without inflammatory bowel disease are not congruent with IBD patients. This overview summarizes the everyday data of recent years and condenses these into four guiding principles. 1) patients with IBD present a risk population for a CDI. A CDI not only worsens the disease activity in the short term, but also causes increased morbidity and mortality in the long term. 2) If a CDI is suspected, glutamate-dehydrogenase (GDH) detection should be carried out quickly. If this is positive, and the disease activity is high, a therapy against C. difficile already may be initiated and—if necessary—terminated in cases of negative confirmation tests. 3) IBD patients with a proven CDI should be treated primarily with vancomycin. 4) In a relapsing CDI, fecal microbiome transfer is an effective therapeutic measure. However, activation of the IBD must be expected in about 15 % of cases. Consistent adherence to these guidelines may help treat a CDI in IBD patients.

Schlüsselwörter

Chronisch-entzündliche Darmerkrankung - Clostridium difficile - fäkaler Mikrobiomtransfer

Key words

clostridium difficile - inflammatory bowel disease - ulcrative colitis - Crohn’s disease - fecal microbiom transfer

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