Vpliv sočasne terapije z zdravili na uspešnost zdravljenja okužbe s Clostridium difficile v Splošni bolnišnici Murska Sobota

Lajnšček, Laura (author), Locatelli, Igor (mentor), Kovačič, Alenka (comentor)

Okužba s Clostridium difficile je v zadnjem desetletju v porastu, tudi v Sloveniji. Pojavi se po predhodnem protimikrobnem zdravljenju in izpostavitvi sporam te bakterije. Klinična slika se kaže od blage diareje pa vse do resnih zapletov kolitisa, ki lahko vodijo v smrt. Dodatno breme bolnikov pa predstavljajo ponovitve okužbe, ki se zgodijo pri skoraj četrtini bolnikov. Z retrospektivno raziskavo v obdobju dveh let smo želeli raziskati dejavnike tveganja za ponovitev okužbe s Clostridium difficile, vezane predvsem na sočasno uporabo zdravil. Vključili smo bolnike, ki so v letih 2016 in 2017 imeli okužbo s Clostridium difficile in bili v Splošni bolnišnici Murska Sobota zdravljeni s peroralnimi odmerki vankomicina. Njihove podatke iz zdravstvene dokumentacije smo statistično analizirali, da bi odkrili morebitne povezave s ponovitvami okužbe v petih tednih. V raziskavi smo zajeli končni vzorec 98 bolnikov s 136 obravnavami okužbe s Clostridium difficile. Glede na našo definicijo ponovitve okužbe v petih tednih je bilo 20,6 % obravnav ponovitev prejšnje okužbe, ki se je zgodila pri 25,5 % bolnikov. V raziskavi smo prepoznali le tri dejavnike tveganja, ki so mejno statistično značilno povečali obete za ponovitve. Zdravljenje s cefalosporini v enem mesecu pred obravnavo okužbe s Clostridium difficile je 2,6-krat povečalo obete za ponovitev (95 % CI: 1,0 – 6,5; p = 0,068). Prav tako je predhodno zdravljenje z metronidazolom 11 dni ali več 4,5-krat povečalo obete za ponovitev (95 % CI: 1,0 – 20,3; p = 0,070). Znotraj pridruženih potencialnih klinično pomembnih interakcij tipa X in D je pridruženost treh ali več tovrstnih interakcij povečala obete za ponovitev 5,7-krat (95 % CI: 1,3 – 24,5; p = 0,022). Z raziskavo nismo uspeli dokazati, da sočasna uporaba zaviralcev protonske črpalke poveča tveganje za ponovitve. Nasprotno se je njihova uporaba nakazovala kot zaščitni dejavnik pred ponovitvami okužbe. Po pričakovanjih se je predhodna uporaba odvajal in sočasna uporaba opioidnih analgetikov nakazovala kot dejavnik tveganja. Na ponovitve okužbe s Clostridium difficile lahko vplivajo tudi dejavniki, ki jih v naši raziskavi nismo spremljali (npr. nadaljnja uporaba protimikrobnih zdravil po okužbi s Clostridium difficile in trajanje predhodne uporabe zaviralcev protonske črpalke). Ti dejavniki bi bili lahko predmet nadaljnjih prospektivnih raziskav.

• Language: Slovenian
• Keywords: Clostridium difficile, ponovitev okužbe, polifarmakoterapija, protimikrobno zdravljenje
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-107970
• Publication date in RUL: 11.06.2019

Secondary language

• Language: English
• Title: Influence of concomitant medication use on eradication of Clostridium difficile in Murska Sobota General Hospital

Abstract

The prevalence of Clostridium difficile infection is increasing in the last decade, also in Slovenia. This infection manifests after antimicrobial treatment and exposure to spores of the bacterium. Clinical presentation ranges from mild diarrhoea to serious complications of colitis, which could be fatal. Recurrent infections are an additional burden for patients and they occur in almost fourth of all patients. With a two-year retrospective research, we intended to research risk factors associated with recurrent Clostridium difficile infection, especially those related to concomitant medicine use. We included all patients with Clostridium difficile infection in 2016 and 2017 that had been treated with oral vancomycin in Murska Sobota General Hospital. Statistical analysis of data in medical records was performed to identify potential relations with recurrences of infection within five weeks. In research we included 98 patients with 136 treatments of Clostridium difficile infection. According to our definition of recurrences within five weeks, 20.6 % of cases met our definition. Recurrences of Clostridium difficile infection occurred in 25.5 % of patients. In research we identified only three factors that have reached borderline statistical significance for increased risk of recurrences. Treatment with cephalosporins in a month before treatment of Clostridium difficile infection has increased odds ratio of recurrence by 2.6 (95 % CI: 1.0 – 6.5; p = 0.068). Furthermore, previous treatment of infection with metronidazole for 11 days or more has increased odds ratio of recurrence 4.5 times (95 % CI: 1.0 – 20.3; p = 0.070). Within concomitant potential clinically important interactions type X and D, the presence of three or more such interactions multiplied odds ratio of recurrence by 5.7 (95 % CI: 1.3 – 24.5; p = 0.022). In our research we failed to prove concomitant proton pump inhibitors as risk factor of recurrences. Their concomitant use contrary tended to be protective factor against recurrence. As expected, the previous use of laxatives and concomitant use of opioids tended to be risk factors. Also other factors that we did not analyse could influence on recurrences of Clostridium difficile infection (e.g. further use of antimicrobials after Clostridium difficile infection and duration of previous therapy with proton pump inhibitors). Those factors could be a subject of further prospective researches.

• Keywords: Clostridium difficile, recurrent infection, polypharmacy, antimicrobial treatment