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Vojnosanitetski pregled
2019, vol. 76, br. 4, str. 392-397
jezik rada: srpski
vrsta rada: originalan članak
doi:10.2298/VSP170321119K

Creative Commons License 4.0
Faktori rizika od pojave relapsa Clostridium difficile infekcije u Kliničkom centru Vojvodina, Srbija: retrospektivna klinička studija
Klinički centar Novi Sad

e-adresa: nadica.kovacevic@mf.uns.ac.rs

Sažetak

Uvod/Cilj: Incidenca relapsne Clostridium difficile infekcije (CDI) je u poslednje dve decenije u porastu. Cilj rada bio je utvrđivanje faktora rizika od relapsa kod bolesnika sa inicijal-nom CDI. Metode. Na Klinici za infektivne bolesti Kliničog centra Vojvodine u Novom Sadu sprovedena je retrospektivna studija u period od januara 2010. do januara 2016. Studijom je obuhvaćeno 488 bolesnika sa inicijalnom CDI koji su lečeni pe-roralnim vankomicinom (125 mg, četiri puta dnevno) ili pero-ralnim metronidazolom (400 mg, tri puta dnevno) 10 dana. Nakon završene terapije bolesnici su praćeni 60 dana u cilju utvrđivanja pojave relapsa. U cilju identifikacije faktora rizika od relapsa CDI upoređivane su demografske, kliničke i labora-torijske karakteristike bolesnika sa relapsom u odnosu na bole-snike sa stabilnim kliničkim odgovorom. Rezultati. Relaps CDI je registrovan kod 142/488 (29,09%) bolesnika od kojih je 22.72% lečeno vankomicinom i 36.60% lečeno metronidazo-lom. Statistički značajan uticaj na relaps CDI su imali komorbi-ditet kao što su maligna oboljenja (19,52% vs 8,82%, p = 0,023) i postoperativna CDI (25,67% vs 10,29%, p = 0,035), hipoal-buminemija (< 25 g/L) (70,27% vs 41,94%, p = 0,034), kon-komitantna antibiotska terapija (50.67% vs 20,29%, p = 0,031). Perzistencija C. difficile toksina u stolici po završenoj terapiji je registrovana kod 22,32% bolesnika lečenih metronidazolom i 9,09% bolesnika lečenih vankomicinom (p = 0,03). Prisustvo toksina C. difficile u stolici nakon uspešno završene terapije inici-jalne CDI nije uticalo signifikantno na pojavu relapsa. Zaklju-čak. Naši rezultati pokazuju da faktore rizika od relapsa CDI predstavljaju komorbiditeti (postoperativna CDI, maligniteti), hipoalbuminemija i konkomitantna primena antibiotika. Van-komicin je efikasniji u eliminaciji toksina C. difficile iz kolona. Prisustvo toksina C. difficile u stolici nakon uspešno završene te-rapije ne utiče signifikantno na pojavu relapsa.

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