Pseudomembranous Enterocolitis

Pseudomembranous enterocolitis (Clostridium difficile-associated diarrhea or Clostridium difficile infection, CDAD; synonyms: Antibiotic-associated enteritis; Antibiotic-associated enterocolitis; Antibiotic-associated colitis; Clostridial enteritis; Clostridial enterocolitis; Colitis pseudomembranacea due to Clostridium difficile; Enterocolitis pseudomembranacea due to Clostridium difficile; Enterocolitis due to Clostridium difficile; Colitis with Clostridia detection; Colitis after antibiosis; Food poisoning due to Clostridium difficile; Pseudomembranous enterocolitis due to Clostridium difficile; Pseudomembranous enterocolitis as defined by antibiotic-associated colitis; Pseudomembranous colitis; Pseudomembranous colitis due to Clostridium difficile; Pseudomembranous colitis as defined by antibiotic-associated colitis ICD-10 A04. 7: Enterocolitis due to Clostridium difficile) is a disease of the gastrointestinal tract (gastrointestinal tract) in which severe, sometimes life-threatening diarrhea (diarrhea) occurs after the use of antibiotics. Clostridium difficile (new name: Clostridioides difficile) is a gram-positive rod bacterium that can form spores. Approximately 95% of cases of pseudomembranous enterocolitis are caused by Clostridium difficile. Clostridium difficile is the most common pathogen of nosocomial (hospital-acquired) and antibiotic-associated diarrheal diseases. The reason is thought to be the high use of broad-spectrum antibiotics (combinations), which are often given over a long period of time. 40% of hospitalized patients excrete the bacterium. Clostridioides difficile infections (CDI), pneumonia/pneumonia (HAP), primary bloodstream infections (BSI), urinary tract infections (UTI), and surgical infections (SSI) account for approximately 80% of all hospital infections (nosocomial infections). Pathogen reservoir: The bacterium occurs ubiquitously (everywhere) in the environment. It can also be detected in the intestinal tract of (young) humans and animals. In young children in up to 80%, in adults only rarely with less than 5%. Occurrence: Clostridium difficile infections (CDI) occur worldwide. Exact data on the contagiousness (infectiousness or transmissibility of the pathogen) are not available. The disease does not occur restricted to one season. Transmission of the pathogen (route of infection) is fecal-oral (infections in which pathogens excreted with feces (fecal) are ingested via the mouth (oral)), e.g., through contaminated drinking water and/or contaminated food. The incubation period (time from infection to outbreak of the disease), in this case the time from antibiotic administration to the onset of symptoms (pseudomembranous colitis in the sense of antibiotic-associated colitis) usually lasts a few days, but may rarely last from weeks to (rarely) months. The duration of the disease varies greatly from individual to individual and may last for months in some circumstances. Sex ratio: Men and women are equally affected. Frequency peak: The disease occurs more frequently in older persons (average age about 76 years) with severe underlying disease/immunosuppression (process that suppresses immunological processes). The incidence (frequency of new cases) is currently increasing annually and amounts to 5-20 cases per 100,000 inhabitants (in Germany). Course and prognosis: The toxins (poisons) secreted by the clostridia cause fever, abdominal discomfort (abdominal pain), severe diarrhea, and fluid and electrolyte losses (→ dehydration). Ribotypes 014 and 020 usually result in milder infection. Ribotypes 027, 017 (toxin-producing), and 078 (toxin-producing) can lead to severe courses of disease. Approximately 4 % of patients show a fulminant course (fulminant colitis). This results in complications such as toxic megacolon (massive dilatation of the colon), perforation of the colon (rupture of the intestine) resulting in peritonitis (inflammation of the peritoneum) and possibly septic shock. Approximately 15 to 20% of patients with Clostridium difficile infection experience a relapse (recurrence of the disease), half of these patients even several times. The lethality of pseudomembranous enterocolitis (mortality in relation to the total number of patients with the disease) depends on the severity of the symptoms, the underlying diseases, and age, and ranges between 3-14%.It has a threefold increased mortality (number of deaths relative to the number of the population in question) in elderly persons with underlying diseases. Passive immunization: Bezlotoxumab, an antibody directed against C. difficile toxin B, can be used to prevent CDI recurrence. The antibody is approved in adults at high risk of recurrence of CDI. In Germany, infectious diarrhea is reportable under the Infection Protection Act (IfSG). Notification has to be made in case of suspected disease, illness, death not by name.