Diareea asociată antibioticelor: factori de risc, forme clinice și tratament

Autori

DOI:

https://doi.org/10.52556/2587-3873.2025.2(104).19

Cuvinte cheie:

diareea asociată antibioticelor, factori de risc, Microfloră intestinală, Clostridioides difficile, tratamentul, antibiotic stewardship

Rezumat

Prezenta revizuire a literaturii analizează datele disponibile privind diareea asociată antibioticelor (DAA), concentrânduse pe identificarea factorilor de risc, caracterizarea formelor clinice și evaluarea eficacității diferitelor regimuri terapeutice. Căutarea sistematică în bazele de date de referință a relevat un volum semnificativ de studii ce evidențiază rolul administrării antibioticelor, impactul dezechilibrului microflorei intestinale și importanța implementării programelor de „antibiotic stewardship”. Printre constatările principale se numără variațiile incidenței DAA în funcție de tipul antibioticelor folosite și predispoziția pacienților în funcție de factori demografici și comorbidități. Rezultatele indică necesitatea elaborării unui algoritm integrat de diagnostic și tratament, care să optimizeze intervențiile clinice și să reducă costurile asociate.

Referințe

1. HARAN, J.P., HAYWARD, G., SKINNER, S. et al. Factors influencing the development of antibiotic associ ated diarrhea in ED patients discharged home: risk of administering IV antibiotics. In: Am J Emerg Med. 2014, vol. 32, nr. 10, pp.1195-1199. ISSN 0735-6757. https://doi.org/10.1016/j.ajem.2014.07.015

2. DONG, N., LI, Z.R., QIN, P. et al. Risk factors for Clostridioides difficile infection in children: a systematic review and meta-analysis. In: J Hosp Infect. 2022, nr. 130, pp. 112-121. ISSN 0195-6701. https://doi.org/10.1016/j.jhin.2022.09.004

3. YANG, S., QIAO, J., ZHANG M. et al. Prevention and treatment of antibiotics-associated adverse effects through the use of probiotics: A review. In: J Adv Res. 2025, nr. 71, pp. 209-226. ISSN 2090-1224. https://doi.org/10.1016/j.jare.2024.06.006

4. MILLER, A.C., ARAKKAL, A.T., SEWELL, D.K. et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. In: Open Forum Infect Dis. 2023, vol. 10, nr. 8, ofad413, ISSN 2328-8957. https://doi.org/10.1093/ofid/ofad413

5. Antibiotic associated diarrhea: symptoms & causes. Mayo Clinic. Published 2021. Accessed April 15 2025. Disponibil: https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231.

6. ScienceDirect. AntibioticAssociated Diarrhea: symptoms range and pathophysiology. 2022. Accessed April 15, 2025. Disponibil: https://www.sciencedi rect.com/topics/nursing-and-health-professions/antibiotic-associated-diarrhea.

7. HUANG, H., LI, L., WU, M. et al. Antibiotics and antibiotic-associated diarrhea: a real-world disproportionality study of the FDA adverse event reporting system from 2004 to 2022. In: BMC Pharmacol Toxicol. 2023, vol. 24, nr. 1, p. 73. ISSN 2050-6511. https://doi.org/10.1186/s40360-023-00710-w

8. SELVARAJ, V., ALSAMMAN, M.A. Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review. In: Brown J Hosp Med. 2022, vol. 2, nr. 1, p. 39745. ISSN 2831-5553. https://doi.org/10.56305/001c.39745

9. McFARLAND, L.V., LI, T. Saccharomyces boulardii CNCM I-745 for prevention of antibiotic-associated diarrhea and Clostridioides difficile in China: systematic review and meta-analysis. In: J Dig Dis Hepatol. 2024, nr. 9, p. 208. ISSN 2574-3511. https://doi.org/10.29011/2574-3511.100208

10. JOHNSON, S., LAVERGNE, V., SKINNER, A.M. et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Up date Guidelines on Management of Clostridioides difficile Infection in Adults. In: Clin Infect Dis. 2021, vol. 73, nr. 5, pp. e1029-e1044. ISSN 1537-6591. https://doi.org/10.1093/cid/ciab549

11. BISHOP, E.J. and TIRUVOIPATI, R. Management of Clostridioides difficile infection in adults and challenges in clinical practice: review and comparison of current IDSA/SHEA, ESCMID and ASID guidelines.In: J Antimicrob Chemother. 2022, vol. 78, nr. 1, pp. 21-30. ISSN 0305-7453. https://doi.org/10.1093/jac/dkac404

12. FINKE, J. Clostridioides difficile Infection: A Focused Guideline Update From the IDSA. In: Am Fam Physician. 2022, vol. 105, nr. 6, pp. 678-679. ISSN 1532-0650.

13. Clostridioides difficile colitis guidelines: oral vancomycin or fidaxomicin preferred. Medscape. Published May 2025. Accessed July 13, 2025. Disponibil: https://emedicine.medscape.com/article/186458-guidelines.

14. GUO, Q., GOLDENBERG, J.Z, HUMPHREY, C. et al. Probiotics for the prevention of pediatric antibioticassociated diarrhea. In: Cochrane Database Syst Rev.2019, vol. 4, nr. 4, CD004827. ISSN 1469-493X.

15. LUKASIK, J., DIERIKX, T., BESSELING-VAN DER VAART, I. et al. Multispecies probiotic for the prevention of antibiotic-associated diarrhea in children: a randomized clinical trial. In: JAMA Pediatr. 2022, vol. 176, nr. 9, pp. 860-866. ISSN 2168-6203. https://doi.org/10.1001/jamapediatrics.2022.1973

16. WANYAMA, H., AKHTAR, T.S., ABBAS, S. Probiotic use reduces the incidence of antibiotic-associated diarrhea among adult patients: a meta-analysis. In: Prz Gastroenterol. 2025, vol. 20, nr. 1, pp. 5-16. ISSN 1895-5770. https://doi.org/10.5114/pg.2025.148486

17. BAUNWALL, S.M.D., LEE, M.M., ERIKSEN, M.K. et al. Faecal microbiota transplantation for recurrent Clostridioides difficile infection: an updated systematic review and meta-analysis. In: EClinicalMedicine. 2020, 2930:100642. ISSN 2589-5370. https://doi.org/10.1016/j.eclinm.2020.100642

18. PEERY, A.F., KELLY, C.R., KAO, D. et al. AGA clinical practice guideline on fecal microbiota-based therapies for select gastrointestinal diseases. In: Gastroenterol ogy.2024, vol. 166, nr. 3, pp. 409-434. ISSN 0016-5085. https://doi.org/10.1053/j.gastro.2024.01.008

19. LI, Y., YANG, Y., YANG, N. et al. Recent advances in fecal microbiota transplantation for Clostridioides difficile infection-associated diarrhea after kidney transplantation. In: Front Microbiomes. 2024, nr. 3: 1409967. SSN 2813-4338. https://doi.org/10.3389/frmbi.2024.1409967

20. CAMMAROTA, G., IANIRO, G., KELLY, C.R. et al. International consensus conference on stool banking for faecal microbiota transplantation in clinical practice. In: Gut. 2019, vol. 68, nr. 12, pp. 2111-2121. ISSN 0017-5749. https://doi.org/10.1136/gutjnl-2019-319548

21. VAN PREHN, J., REIGADAS, E., AGUILAR, D. et al. 2021 update of the ESCMID treatment guidance document for Clostridioides difficile infection: comparison of vancomycin versus metronidazole stratified by disease severity. In: Clin Microbiol Infect. 2021, nr. 27, suppl 2, ss. 1-21. ISSN 234-456.

22. LEFFLER, D.A., LAMONT, J.T Clostridium difficile infection. In: N Engl J Med. 2015, vol. 372, nr. 16, pp. 1539-1548. ISSN 0028-4793. https://doi.org/10.1056/NEJMra1403772

23. DAI, M., LIU, Y., CHEN, W. et al. Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients. In: Crit Care. 2019, vol 23, nr. 1, p.:324. ISSN 1364-8535. https://doi.org/10.1186/s13054-019-2604-5

24. WANYAMA, H., AKHTAR, T.S., ABBAS, S. Probiotic use reduces the incidence of antibioticassociated diarrhea among adult patients: a metaanalysis. In: Prz Gastroenterol. 2025, vol. 20, nr. 1, pp. 5-16. ISSN 1895-5770. https://doi.org/10.5114/pg.2025.148486

25. HODZHEV, V., DZHAMBAZOV, K., SAPUNDZIEV, N. et al. Highdose probiotic mix of Lactobacillus spp., Bifidobacterium spp., Bacillus coagulans, and Saccharomyces boulardii to prevent antibioticassoci ated diarrhea in adults: a multicenter, randomized, doubleblind, placebocontrolled trial (SPAADA). In: Open Forum Infect Dis. 2024; vol. 11, nr. 11), p. 615. ISSN 2328-8957. https://doi.org/10.1093/ofid/ofae615

26. FEUERSTADT, P., LOUIE, T.J., LASHNER, B. et al. SER109, an oral microbiome therapy for recurrent Clostridioides difficile infection. In: N Engl J Med. 2022; vol. 386, nr. 3, pp. 220229. ISSN 0028-4793. https://doi.org/10.1056/NEJMoa2106516

27. SCHOENFELD, P., KELLY, C.R. RBX2660: first-in-class live biotherapeutic product for recurrent Clostridioides difficileinfection. In: Evidence-Based GI. 2022

Dec:1-6. Accessed July 13, 2025. Available from: https://gi.org/wp-content/uploads/2022/12/Kelly_dec2022.pdf.

28. VICKERS, R.J., TILLOTSON, G.S., NATHAN, R. et al; CoDIFy Study Group. Efficacy and safety of ridinilazole compared with vancomycin for the treatment of Clostridioides difficile infection: a phase 2, randomized, double-blind, active-controlled, non-inferiority study. Lancet Infect Dis. 2017, vol. 17, nr. 7, pp. 735-744. ISSN 1473-3099 https://doi.org/10.1016/S1473-3099(17)30235-9

Descărcări

Publicat

01.12.2025

Număr

Nr. 2(104) (2025): Supliment. Al VI-lea Congres Național de Gastroenterologie și Hepatologie din Republica Moldova cu participare internațională

Secțiune

Articole

Licență

Creative Commons License

Această lucrare este licențiată în temeiul Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Cum cităm

[1]
Negru, I. and Turcan, S. 2025. Diareea asociată antibioticelor: factori de risc, forme clinice și tratament. Public Health Economy and Management in Medicine. 2(104) (Dec. 2025), 105–109. DOI:https://doi.org/10.52556/2587-3873.2025.2(104).19.

Articole similare

1-10 of 381

Puteți, de asemenea, începeți o căutare avansată de similaritate pentru acest articol.