Diagnosis and treatment of four liver cirrhosis cases complicated with Clostridium difficile infection and literature review

doi:10.3877/cma.j.issn.1674-1358.2020.04.016

Abstract

Abstract:

Objective

To investigate the characteristics and prognosis of Clostridium difficile infection in patients with advance liver cirrhosis.

Methods

From January 2018 to May 2019, four cases were diagnosed with Clostridium difficile infection and liver cirrhosis in Beijing Ditan Hospital, Capital Medical University. The diagnosis, treatment and clinical outcome of the four cases were analyzed, respectively and relevant literature were reviewed.

Results

All cases with initial episode with Clostridium difficile infection were advanced liver cirrhosis patients with various complications. A definite diagnosis was performed by fecal detection of Clostridium difficile gluconate dehydrogenase (GDH) combined with toxin enzyme-linked immunosorbent assay. There were 3 cases with fulminant type and 1 case recurred. All 4 cases were treated with vancomycin. Two cases died within one year after onset, among whom one case died within 24 h.

Conclusions

Improving clinical cognition, perfect diagnosis test, timely diagnosis and treatment of Clostridium difficile in patients with liver cirrhosis was essential to reduce the incidence and morbidity.

Key words: Clostridium difficile, Liver cirrhosis, Diarrhea, Drug therapy

Shan Hong, Xu Chen, Julong Hu, Ping Li. Diagnosis and treatment of four liver cirrhosis cases complicated with Clostridium difficile infection and literature review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(04): 348-351.

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References 28

[1]	Meyyur Aravamudan V, Khan SR, Hussain I. Clostridium difficile Infection in liver cirrhosis carries a higher risk of mortality: A comprehensive literature review[J]. cureus,2019,11(8):e5463.
[2]	Bartlett JG, Chang TW, Gurwith M, et al. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia[J]. N Engl J Med,1978,298(10):531-534.
[3]	Bartlett JG. Clinical practice. Antibiotic-associated diarrhea[J]. N Engl J Med,2002,346(5):334-339.
[4]	Crobach MJ, Planche T, Eckert C, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection[J]. Clin Microbiol Infect,2016,22(Suppl 4):S63-S81.
[5]	Leffler DA, Lamont JT. Clostridium difficile infection[J]. N Engl J Med,2015,372(16):1539-1548.
[6]	Jin K, Wang S, Huang Z, et al. Clostridium difficile infections in China[J]. J Biomed Res,2010,24(6):411-416.
[7]	徐英春, 张曼. 中国成人艰难梭菌感染诊断和治疗专家共识[J]. 协和医学杂志,2017,8(2):131-138.
[8]	Tang C, Cui L, Xu Y, et al. The incidence and drug resistance of Clostridium difficile infection in Mainland China: a systematic review and meta-analysis[J]. Sci Rep,2016,6:37865.
[9]	Mavros MN, Alexiou VG, Vardakas KZ, et al. Underestimation of Clostridium difficile infection among clinicians: an international survey[J]. Eur J Clin Microbiol Infect Dis,2012,31(9):2439-2444.
[10]	Vanjak D, Girault G, Branger C, et al. Risk factors for Clostridium difficile infection in a hepatology ward[J]. Infect Control Hosp Epidemiol,2017,28(2):202-204.
[11]	Bajaj JS, Ananthakrishnan AN, Hafeezullah M, et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: A national and tertiary center perspective[J]. Am J Gastroenterol, 2010 ,105(1):106-113.
[12]	Pop A, Procopet B, Stefanescu H, et al. Clostridium difficile screening in cirrhosis: one for all, or some for one?[J]. Dig Dis Sci,2015,60(12):3825-3826.
[13]	Asempa TE, Nicolau DP. Clostridium difficile infection in the elderly: an update on management[J]. Clin Interv Aging,2017,12:1799-1809.
[14]	Căruntu FA, Gheorghiță V. Clostridium difficile infection in hospitalized cirrhotic patients with hepatic encephalopathy[J]. J Gastrointestin Liver Dis,2016,25(1):120-121.
[15]	Yan D, Huang YD, Chen YB, et al. Risk factors for Clostridium difficile infection in cirrhotic patients[J]. Hepatobiliary Pancreat Dis Int,2019,;18(3):237-241.
[16]	Garcia-Tsao G, Lim JK. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program[J]. Am J Gastroenterol, 2019,104(7):1802-1829.
[17]	Brown MR, Jones G, Nash KL, et al. Antibiotic prophylaxis in variceal hemorrhage: timing, effective-ness and Clostridium difficile rates[J]. World J Gastroenterol,2010,16(42): 5317-5323.
[18]	Dultz G, Piiper A, Zeuzem S, et al. Proton pump inhibitor treatment is associated with the severity of liver disease and increased mortality in patients with cirrhosis[J]. Aliment Pharmacol Ther,2015,41(5):459-466.
[19]	Smith EZ, Northup PG, Argo CK. Predictors of mortality in cirrhosis inpatients with Clostridium difficile infection[J]. J Clin Gastroenterol, 2018,52(8):747-751.
[20]	庞君丽, 崔恩博, 曲芬. 肝硬化消化道出血合并艰难梭菌感染1例[J]. 传染病信息,2015,28(4):244-245.
[21]	Saha S, Khanna S. Management of Clostridioides difficile colitis: insights for the gastroenterologist[J]. Therap Adv Gastroenterol,2019;12:1-15.
[22]	Olmedo M, Reigadas E, Valerio M, et al. Is it reasonable to perform fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with liver cirrhosis?[J]. Rev Esp Quimioter,2019,32(2):205-207.
[23]	Bajaj JS, Ananthakrishnan AN, Hafeezullah M, et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: a national and tertiary center perspective[J]. Am J Gastroenterol, 2010,105(1):106-113.
[24]	Smith EZ, Northup PG, Argo CK. Predictors of mortality in cirrhosis inpatients with Clostridium difficile infection[J]. J Clin Gastroenterol,2018,52(8):747-751.
[25]	Hong SJ, Feuerstadt P, Brandt LJ. MELD is the only predictor of short-term mortality in cirrhotic patients with C. difficile infection[J]. Dig Liver Dis,2019,51(2):275-280.
[26]	Kruger AJ, Durkin C, Mumtaz K, et al. Early readmission predicts increased mortality in cirrhosis patients after Clostridium difficile infection[J]. J Clin Gastroenterol,2019,53(8):e322-e327.,
[27]	Fehér C, Mensa J. A comparison of current guidelines of five international societies on Clostridium difficile infection management[J]. Infect Dis Ther,2016,5(3):207-230.
[28]	Saab S, Alper T, Sernas E, et al. Hospitalized patients with cirrhosis should be screened for Clostridium difficile colitis[J]. Dig Dis Sci,2015,60(10):3124-3129.

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