nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2014-0-1-25-31nodgo-11Research ArticleОригинальные исследованияЭнтероколит, связанный с Clostridium difficile, в детской гематологии-онкологии – решенная проблема? Обзор литературы и собственный опытIs Clostridium difficule-associated enterocolitis in pediatric hematology/oncology a solved problem? A review of literature and the authors’ experienceКиргизовКирилл ИгоревичKirgizovK. I.

Москва

Moscow

nodgo@yandex.ruШульгаС. Ю.ShulgaS. Yu

Москва

Moscow

ПристансковаЕ. А.PristanskovaYe. A.

Москва

Moscow

КонстантиноваВ. В.KonstantinovaV. V.

Москва

Moscow

ГерасимоваЮ. В.GerasimovaYu. V.

Москва

Moscow

СидороваН. В.SidorovaN. V.

Москва

Moscow

БлагонравоваО. Л.BlagonravovaO. L.

Москва

Moscow

ФедороваН. И.FedorovaN. I.

Москва

Moscow

СкоробогатоваЕ. В.SkorobogatovaYe. V.

Москва

Moscow

ФГБУ «Российская детская клиническая больница» Минздрава России; ФГБУ «Федеральный научно-клинический центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава РоссииРоссияRussian Children’s Clinical Hospital, Ministry of Health of Russia; Federal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Ministry of Health of RussiaRussian FederationФГБУ «Российская детская клиническая больница» Минздрава РоссииРоссияRussian Children’s Clinical Hospital, Ministry of Health of RussiaRussian Federation201431032015012531Copyright © Киргизов К.И., Шульга С.Ю., Пристанскова Е.А., Константинова В.В., Герасимова Ю.В., Сидорова Н.В., Благонравова О.Л., Федорова Н.И., Скоробогатова Е.В., 20152015Киргизов К.И., Шульга С.Ю., Пристанскова Е.А., Константинова В.В., Герасимова Ю.В., Сидорова Н.В., Благонравова О.Л., Федорова Н.И., Скоробогатова Е.В.Kirgizov K.I., Shulga S.Y., Pristanskova Y.A., Konstantinova V.V., Gerasimova Y.V., Sidorova N.V., Blagonravova O.L., Fedorova N.I., Skorobogatova Y.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/11

По данным ряда исследований в США, Европе и Азиатских странах, Clostridium difficile является самой частой причиной нозокомиальных диарей. Важно, что иногда связанные с Cl. difficile колиты могут приводить к летальному исходу у пациентов с тяжелыми сопутствующими заболеваниями. Не являются исключением и дети с гематологическими, онкологическими и иными тяжелыми заболеваниями. У данной группы пациентов могут развиваться ассоциированные с Cl. difficile энтероколиты, приводящие к серьезным последствиям. Еще бо́льшую угрозу данные осложнения несут для пациентов после трансплантации гемопоэтических стволовых клеток. Длительно персистирующая клостридиальная инфекция ведет к росту длительности  госпитализации, затрат на лекарственные препараты и значимому поражению кишечника, которое может быть причиной развития различных осложнений и, например, провоцировать реакцию «трансплантат против хозяина». В последние годы происходит снижение выявленных случаев энтероколитов, вызванных Cl. difficile. Однако до сих пор данная проблема занимает значимое место в списке осложнений химиотерапии.

В данной статье речь пойдет об эпидемиологии, диагностике и терапии различных вариантов Cl. difficile-ассоциированных энтероколитов. Кроме того, будет представлен собственный опыт профилактического приема препарата рифаксимин с целью предотвращения данного осложнения у детей в контексте трансплантации гемопоэтических стволовых клеток.

 

According to a number of trials in the USA, Europe, and Asia, Clostridium difficule is the most common cause of nosocomial diarrheas. It is significant that Cl. difficule-associated colitis may occasionally result in death in patients with severe comorbidities. Children with hematological, oncological and other severe diseases are no exception. This patient group may develop Cl. difficule-associated enterocolitides that lead to serious consequences. These complications bring a much greater threat to patients after hematopoietic stem cell transplantation. Long-term persistent Cl. difficule infection causes an increase in hospitalization length, drug costs, and a  significant bowel lesion that may induce various complications and, as an example, graft-versus-host disease. There has been recently a decrease in the detection rates of Cl. difficule-induced enterocolitides. However, this problem has held a high position in the list of chemotherapy complications so far.

This paper deals with the epidemiology, diagnosis, and therapy of different types of Cl. difficule-associated enterocolitides, as well the authors’ experience with rifaximin used to prevent this complication in children in the context of hematopoietic stem cell transplantation.

 

 

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The authors declare that there are no conflicts of interest present.