Volume 04 Issue 06-2024
12
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
06
P
AGES
:
12-17
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Interest in studying the problem of diarrhea in children is due to their wide distribution (1-1.2 billion cases per year
worldwide according to WHO, 2010), polyetiology, difficulty of differential diagnosis and tendency to acute and
chronic course. In recent years, foreign and domestic authors have attached increasing importance to the so-called
antibiotic-associated diarrhea (AAD), components: 6-40% in the structure of intestinal diseases. In the etiological
structure of AAD in young children, the share of C.difficile infection was 47%. A rusk factor for development is also
combination therapy with antibiotics.
KEYWORDS
Clostridium difficile, antibiotic-associated diarrhea, young children.
INTRODUCTION
Research Article
THE ROLE OF CLOSTRIDIUM DIFFICILE IN THE DEVELOPMENT OF
ANTIBIOTIC-ASSOCIATED DIARRHEA IN EARLY-AGED CHILDREN
Submission Date:
May 31, 2024,
Accepted Date:
June 05, 2024,
Published Date:
June 10, 2024
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume04Issue06-03
Rabbimova Dilfuza Toshtemirovna
The head of the department of propaedutics of children's diseases, associate professor at Samarkand State
Medical University, Uzbekistan
Shavdirova Gulbonu Mansurovna
Doctoral student at the Department of propaedeutics of children's diseases at Samarkand State Medical
University, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 06-2024
13
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
04
ISSUE
06
P
AGES
:
12-17
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
The emergence of antibiotics made it possible to treat
many serious life-threatening infections and save the
lives of many people. However, widespread and
uncontrolled use of various groups of antibacterial
drugs, especially in outpatient settings, leads to the
development of many negative effects.
In the last 10 years, the use of antibiotics worldwide has
increased by 36% [1]. Antibiotic resistance has led to
increased use of backup antibiotics, for example, the
use of carbopenems increased by 45% and polymyxins
by 13%.
Antibacterial therapy affects not only intestinal
microflora disorders, allergic reactions and antibiotic
resistance, but also type II diabetes, metabolic
syndrome, atopic dermatitis, bronchial asthma, cancer,
and even myocardial infarction [2-3]. One of the
frequent complications of antibacterial therapy can be
the development of antibiotic-related diarrhea.
According to the WHO definition, antibiotic-associated
diarrhea is characterized by an increase in the
frequency of stool (more than 3 times a day) that
occurs during or within 8 weeks after the end of
antibacterial therapy, and its volume increases,
along with a change in consistency, it is
represented by the appearance of pathological
mixtures in the form of mucus, green and blood.
According to various epidemiological observations,
antibiotic-related diarrhea develops in an average of 5-
30% of patients receiving antibiotics [4]. The
frequency of antibiotic-related complications in
children is more than 11% after the use of broad-
spectrum antibiotics, and increases to 42% in
immunocompromised children [5].
The incidence of antibiotic-associated diarrhea in
hospitals is 20-25%, but in recent years, the free supply
of drugs, including antibiotics, has led to an increase in
the number of antibiotic-associated diarrhea in
outpatient settings. Antibiotic-associated diarrhea may
be mild in patients, and in some cases, symptoms
resolve when the antibiotic is discontinued. Clinical
symptoms may appear even after 8 weeks after the
end of the course of antibiotic therapy and cause
a deepening of the pathological process, which
significantly
complicates
the
diagnosis.
Pseudomembranous colitis (PMK), which is one of the
dangerous forms, develops.
Antibiotic-related diarrhea can be caused by any
antibacterial drug, especially if it is highly active against
anaerobes. Antibiotics that cause the greatest risk of
developing antibiotic-related diarrhea are clindamycin,
lincomycin, aminopenicillins, II and III generation
cephalosporins. According to L.Mc Farland (1993), 5-
10% of antibiotic-related diarrhea cases are caused by
ampicillin,
10-25%
by
second-generation
cephalosporins, and only 2-5% by others (tetracycline,
macrolides, nitrofurans, co- develops when using
trimoxazole, fluoroquinolines, aminoglycosides).
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International Journal of Medical Sciences And Clinical Research
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VOLUME
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P
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OCLC
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1121105677
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It should be noted that the dose, method and
frequency of taking antibiotics do not affect the risk of
developing complications related to antibiotics.
Diarrhea during antibacterial therapy can be infectious
or non-infectious. Non-infectious antibiotic-related
diarrhea is associated with intestinal motility disorders,
toxic effects on the intestinal epithelium, bile acid and
carbohydrate metabolism disorders in the intestine,
etc. For example, macrolides stimulate motulin
receptors, which cause contraction of the smooth
muscles of the antral part of the stomach and
duodenum, which subsequently leads to the
development of diarrhea [6]. The toxic effect of
tetracycline and neomycin on the mucous membrane
of the gastrointestinal tract is manifested by the direct
death of epithelial cells, infiltration of plasma cells,
eosinophils and macrophages. This is accompanied by
a decrease in the absorption of water and electrolytes
in the intestinal villi.
The infectious nature of antibiotic-related diarrhea can
be etiologically associated with various pathogens -
Clostridium
perfringius,
Salmonella
species,
Clostridium difficile, which are able to colonize the
intestines by replacing the normal microflora. Many
researchers believe that one of the most important
infectious agents is Clostridium difficile (C.difficile),
which accounts for 10-25% of all antibiotic-associated
diarrhea and 90-100% of cases of pseudomembranous
colitis.
However, for the development of manifest forms of
infections caused by C.difficile, not only the
colonization of the intestine with toxigenic strains of
the pathogen, but also the presence of risk factors
are of great importance, including the use of certain
groups of antibiotics, the age of patients, the
characteristics of the main and concomitant diseases,
hospital stay The period of eating, the condition of the
intestinal microflora, etc. can be the cause. A high risk
factor for the development of diarrhea associated with
C.difficile in children of early age is more characterized
by the polymorphism of clinical manifestations in the
gastrointestinal tract, which is of great importance for
timely diagnosis and adequate therapy.
Currently, the role of Clostridium difficile in antibiotic-
associated diarrhea has been studied more in older
patients [8.9]. On the contrary, in pediatric practice,
many aspects of this problem are related to
Clostridium difficile infection, and the differential
diagnostic issues of antibiotic-related diarrhea of non-
infectious origin have not yet been fully resolved, and
the nature of infectiousness has not yet been
sufficiently studied. In addition, criteria for early
diagnosis, taking into account risk factors for the
development of Clostridium difficile infection, have not
been developed, and the degree of damage in the
gastrointestinal tract and the informative value of
signs of inflammation of the large intestine have not
yet been fully studied.
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International Journal of Medical Sciences And Clinical Research
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VOLUME
04
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
The purpose of the study: to determine the role of
Clostridium difficile infection in early-aged children
with antibiotic-associated diarrhea.
METHODS
This study was conducted in the Samarkand regional
multidisciplinary medical center (head doctor-prof.
M.K. Azizov ), 68 children aged 2 months to 1.5 years
with antibiotic-related diarrhea were observed.
Antibiotic-associated diarrhea is defined as 3 or more
episodes of loose stools over 2 or more days, unless
another cause is identified (WHO, 2002).
76.5% (52 children) of the examined patients with
antibiotic-related diarrhea are children under one year
of age. In age groups older than 1 year - 23.5% (17
patients).
38 (55.8%) of the examined children were boys, 30
(44.1%) were girls, gender differences were not
identified. Children with antibiotic-related diarrhea
treated in gastroenterology and pulmonology
departments were included in the study.
According to the characteristics of the degree of
damage in antibiotic-related diarrhea, 3 main forms of
gastroenteritis, enterocolitis and hemocolitis were
identified. More than half of children (57.5%) had
antibiotic-related
diarrhea
with
symptoms
of
gastroenteritis (39 patients), 22 (30.1%) patients
developed enterocolitis, 7 (10.2%) patients developed
hemocolitis.
Depending on the severity and duration of toxicosis
and exicosis, vomiting and diarrhea syndrome, fever,
etc., 62 patients (91.2%) and 6 patients (8.8%) with
severe form found in children.
Laboratory examinations include general blood
analysis, coprology, biochemical blood analysis and
bacteriological examination of feces. In addition,
laboratory tests include the detection of Clostridium
difficile and its toxins A and B using the QIAGEN GmbH
(Germany) equipment by polymerase chain reaction.
The specificity of the test is 96.2%, the sensitivity is
95.8%.
RESULTS
Clostridium difficile infection was detected in 32 out of
68 patients with antibiotic-related diarrhea, which is
47%. Toxins A and B were detected in children with
antibiotic-related diarrhea during hospitalization, and
this is 18.7% (6 people).
When analyzing the prevalence of Clostridium difficile
infection among children treated with different
nosologies, it was found that its ratio is high among
children with gastroenterological pathology during the
use of antibacterial therapy, which is related to the
degree of damage to the gastrointestinal tract and the
Volume 04 Issue 06-2024
16
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
04
ISSUE
06
P
AGES
:
12-17
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
severity of the disease, as well as the degree of
inflammation in the intestines was found to be related.
When studying the effect of the method of using
antibacterial therapy on the detection of Clostridium
difficile infection, the risk of developing this infection
when taking antibiotics enterally, the manifestation of
clinical manifestations of antibiotic-related diarrhea
was 68%, and 31.25 when taking parenterally found in %
of cases.
We found that a risk factor for the development of
Clostridium difficile infection was combined antibiotic
therapy: the frequency of combined therapy was 65.6%
(22 patients). This is explained by the fact that taking
several antibiotics at the same time increases their
negative impact on the microecological relationship in
the gastrointestinal tract, expands the range of toxic
effects and, as a result, creates additional conditions
for the growth and colonization of Clostridium
difficile. In our study, it was found that ampicillin
(34.4%) and III generation cephalosporin (28.2%) were
the most common antibiotics in the formation of
C. difficile toxins and the development of the disease.
A risk factor for the development of C. difficile
infection is combination therapy with antibiotics:C.
difficile-positive group used this treatment option
more frequently than C. difficile-negative group (59%
significantly higher than 37.70%, respectively, p=0.011).
This is explained by the fact that taking several
antibiotics at the same time increases their negative
impact on the microecological relationship in the
gastrointestinal tract, expands the range of toxic
effects and, as a result, creates additional conditions
for the growth and colonization of C. difficile.
CONCLUSION
In conclusion, the share of C. difficile infection in the
etiological structure of antibiotic-related diarrhea in
early-aged children is 47%. A risk factor for
development is antibacterial therapy combined with
antibiotics.
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VOLUME
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Publisher:
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