Tratamentul infecţiilor urinare asociate la pacienţii cu enterocolită cu clostridium difficile - o provocare? | [Treatment of urinary tract infections associated to patients with clostridium difficile colitis – a challenge?]

Abstract

Clostridium difficile infection (ICD) represents a major public health problem because of increased incidence, high risk of relapse and severe complications, and increased hospitalization costs. An important factor in the development of colitis is previous exposure to antibiotics (especially cephalosporins, fluoroquinolones, and ampicillin/amoxicillin). Urinary tract infections (UTI) are very common, produced most often by Escherichia coli and other bacteria (Proteus spp., Enterobacter spp., Klebsiella spp., etc.), frequently presenting varied sensitivity to antibiotics. Concomitant treatment of the two infections requires the correct choice, to not worsen the evolution of colitis. The objective of this study was to evaluate the etiology of UTI identified in hospitalized patients with Clostridium difficile colitis in the Clinical Infectious Diseases Hospital of Brasov from Jan.-Nov. 2018 and treatment possibilities based on sensitivity testing, without exacerbation of colitis. Of 187 patients admitted with ICD in 33.69% of cases, a UTI was also diagnosed, determined in particular by Klebsiella pneumonia – 34.92% cases and Escherichia coli – 23.81% cases. In the context of the two concomitant infections treatment of UTI can be difficult. Based on resistance and sensitivity tests to Meropenem (15/15 cases for Escherichia coli and 17/22 cases for Klebsiella pneumoniae) treatment with carbapenem may be the choice for UTI therapy.