Clostridium difficile

Prevention of Clostridium difficile-Associated Diarrhea Using Probiotics

.

1. Clostridium difficile
2.
3. Clostridium difficile
4.
Clostridium difficile

Clostridium difficile
C. difficile

C.
difficile


C. difficile

: , Clostridium difficile,

(diarrhea) 3 24
1 72
14 2
,
, , auranofin (gold salt), (clindamycin, tetracyclines, sulfonamides,
broad-spectrum antibiotics ), (reserpine, guanethidine, methyldopa, guanabenz,
guanadrel, angiotensin-converting enzyme inhibitors), cholinergics (bethanechol, neostigmine),
(quinidine, digitalis, digoxin), , misoprostol,
colchicine, proton pump inhibitors (PPIs) H2-receptor blockers 2
Clostridium difficile
3
C. difficile
C. difficile
(colitis) 2
actin
disaggregation
depolymerization filamentous actin 4
3
C. difficile 3 24
C. difficile pseudomembranous colitis
5 ( clindamycin, cephalosporins,
fluoroquinolones, ampicillin, amoxicillin)5-7
(H2 blockers
PPIs) (tube feeding)5, 6, 8

(normal flora)
C. difficile
9
C.
difficile .. 2555
23 C. difficile
C. difficile PPIs 1.4-2.75
PPIs
PPIs10 PPIs
C. difficile 11 C. difficile PPIs
12, 13
.. 2554 C. difficile 453,000
29,000 14 .. 2553-2554 15
250 C. difficile 25.6
( 28.6) ( 45.8)
(comorbidity)
1 15
.. 2554 C. difficile
15,461 65.8 24.2
65
16 C. difficile
433 .. 2549-2556 63
14.55 17 20
C. difficile3
C. difficile metronidazole
vancomycin
5 2

1 60 38.3
2.5 15,000
2 pseudomembranous colitis 18
metronidazole 250 4 500
3 10-14 4, 5, 19, 20 500 8 21
metronidazole 22 10 7
vancomycin 125 4 10-14 4, 5, 19, 20
vancomycin vancomycin C. difficile
vancomycin
4, 5, 19 vancomycin metronidazole
vancomycin
4, 5 fidaxomicin 19, 21 200 2
C. difficile
(bioavailability) 4

Lactobacillus Bifidobacterium
Saccharomyces boulardii
23
-

24
1
(antibiotic-associated diarrhea)

C. difficile (C. difficile colitis) (infectious diarrhea) (inflammatory

bowel disease) (irritable bowel syndrome) 25
1 25, 26

Escherichia coli 1917 Nissle

Lactobacillus salivarius UCC4331
Lactobacillus reuteri
Lactobacillus casei
Lactobacillus plantarum 299v
Lactobacillus rhamnosus GG
Bifidobacterium infantis 35624
Bifidobacterium animalis DN-173010
Bifidobacterium longum
Clostridium butyricum M588
Clostridium difficile VP20621
Saccharomyces boulardii

Actimel
Lactobacillus casei
Lactobacillus bulgaricus
Streptococcus thermophilus
Bio-K+CL1285
Lactobacillus casei
Lactobacillus acidophilus
Florajen3
Lactobacillus acidophilus
Bifidobacterium bifidum
VSL #3
Streptococcus thermophilus
Bifidobacterium breve
Bifidobacterium longum
Bifidobacterium infantis
Lactobacillus acidophilus
Lactobacillus plantarum
Lactobacillus casei
Lactobacillus bulgaricus

1.
2.
3. (bacterial flora)
(nutrient fermentation)
4. (epithelial barrier function)
5. -opioid cannabinoid receptors
6. (visceral hypersensitivity)
(spinal afferent traffic) (stress response)25

C. difficile

C. difficile 27 meta-analysis .. 2549
S. boulardii, L. rhamnosus GG
C. difficile pooled relative risk 0.59
(0.41-0.85) 95% S. boulardii
C. difficile 28
.. 2555 metaanalysis S. boulardii L. acidophilus CL1285 L. casei
LBC80R pooled relative risk 0.39 (0.19-0.79) 95%
C. difficile 26 Johnston
systematic review meta-analysis
1,659 randomized, controlled trial
20
(Bifidobacterium, Lactobacillus, Saccharomyces, Streptococcus species) C.

difficile 3,818
1,974 1,844
pooled relative risk ( 95%) 0.34 (0.24-0.49)29
31 4,492
pooled relative risk ( 95%) 0.36
(0.26-0.51)30 C.
difficile
10 x 109 CFU/29
29, 30 meta-analysis Hempel (2012)
(Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus /
Bacillus) C. difficile pooled relative risk (
95%) 0.29 (0.17-0.48) p < 0.00131 Allen ..
2556 C. difficile
65 multicenter, randomized, doubleblind, placebo-controlled trial 2
1,471 (L.
acidophilus 2 B. bifidum B. lactis) 6 x 1010 / 21 1,470
C. difficile
(relative risk 0.71 (0.34-1.47) 95%, p = 0.35)32
Xie C. difficile 33



27, 34
C. difficile27, 35,
36
C. difficile

meta-analysis
29, 30 2 pooled relative risk ( 95%)
0.82 (0.65-1.05)29 0.89 (0.64-1.24)30 Allen

relative risk 1.26 (1.00-1.59) 8.06 (1.01-64.48) p value 0.045
0.019 32 (fungemia) S. boulardii
(subtype S. cerevisiae) IV catheter 37
Lactobacillus (endocarditis)
(bacteremia) sepsis 25, 38 severe acute
pancreatitis
(relative risk 2.53 (1.22-5.25) 95%)39
37
lactose lactose
S. boulardii

C. difficile
C. difficile
C. difficile





C. difficile

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