Стан проблеми захворювань, пов’язаних з C. difficile інфекцією, в Україні та світі

Abstract

В статті наведені показники захворюваності на Clostridium difficile інфекцію в Україні та в інших країнах світу, відмічені головні фактори ризику виникнення інфекції та розвитку ускладнень. Вказані головні напрямки їх попередження; В статье приведены показатели заболеваемости Clostridium difficile инфекцией в Украине и в других странах мира, отмечены главные факторы риска возникновения инфекции и развития осложнений. Указаны главные направления их предупреждения; In recent year the amount of cases of the entestinal infection conditioned by a potential pathogenic microflora increased as a result of the wide and out-of-control use of antibiotics. Presently C. difficile acknowledge to one of basic causative agents of antibiotic-association diarrhea and enterocolitis. To beginning of era of antibiotics a pseudomembranosus colitis (PMC) met rarely enough. Every year 3-4 cases registered oneself only, and a diagnosis was set only after autopsia after characteristic changes in bowels. With beginning of era of antibiotics the number of patients on PMC began headily to grow. First C. difficile was distinguished in 1935 of Holl and O’Toole, as a representative of natural microflora of baby. Not only antibacterial preparations (clindamycin, aminopenicillins, cephalosporin of III generation) but also any other preparations (antineoplastics, preparations of platinum, cyclophosphamides, antimetabolites) assist development of infection able to violate the microflora of bowels. For today in the whole world of C. difficile infection (CDI) is officially examined as nosocomyal, this problem is carefully studied, conduct scale monitoring researches. Yes, in the USA, studies are undertaken by the Federal agency from a health protection and quality, showed that amount of hospitals patients with the diagnosis of CDI establishments unceasingly grows in clinic: 1993 year - 85,7 thousand persons, 2010 year- 346,8 thousand persons, 2013 year - 350,0 thousand persons. A death from CDI in the USA grew from 1999 for 2013 in 10 times. Annually 15-20 thousand patients die from CDI. In Ukraine official registration of CDI is absent, that is why official indexes of morbidity and death are absent. The plenty enough of various tests is presently for diagnostics of CDI. It is cytopatogenic test and reaction of neutralization of toxin (determination of toxin В), latex-agglutination (determination of glytamatdehydrogenase), IFA (determination of toxin A or A and B simultaneously), PCR. But from data of some researchers the reliable with deployment method of diagnostics of C. Difficile infection is a cultural method (bacteriological) that has a high sensitiveness. In the same time it is known that selection of causative agent and his authentication without determination of ability to product a toxin is insufficient, in fact no toxigenic strains do not act part in pathology of man. Thus, a bacteriological method without determination of toxigenic properties of strains can not be used, as an independent method of diagnostics. Thus, expedient is further determination of toxigenicity of the distinguished strains by other methods (for example, cytopatogenic test in the culture of cells). Presently in Ukraine the modern methods of diagnostics (PCR, IFA and other) did not get sufficient distribution in the laboratories of state establishments of health protection in connection with their complication and jewellery, in addition they can not provide all aspects of decision of this problem. To the article the indexes of morbidity are driven on Clostridium difficile infection in Ukraine and in other countries of the world, main factors of risk of origin of infection and development of complications are marked. Main directions of their warning are indicated.