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Clostridium difficile-infektion

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Defintion:
Tarminfektion orsakad av bakterien C. difficile, ofta till följd av antibiotikabehandling inom de senaste två veckorna.
Förekomst:
Incidensen i Sverige var 66 fall/100 000 invånare och cirka 10 fall/10 000 vårddagar under 2016.
Symtom:
Frekvent och lös avföring, av och till med blod eller slem, ofta i kombination med bukmärtor och feber. Diarré som börjar under eller efter avslutad antibiotikabehandling, särskilt i samband med sjukhusvård, bör alltid misstänkas vara C. difficile-infektion.
Kliniska fynd:
Förloppet kan vara milt och självbegränsande men progredierar ibland till kolit, som i sällsynta fall blir fulminant med ileus och toxisk dilatation.
Diagnostik:
Avföringsprov för toxinbestämning och eventuellt för odling. Kompletterande prover för bedömning av svårighetsgrad innefattar CRP, blodstatus, elektrolyter, kreatinin och albumin.
Behandling:
Vid lätta besvär avslutas pågående antibiotikabehandling eller ändras till antibiotika med mindre påverkan på tarmfloran. Läkemedelsbehandling är i första hand metronidazol eller vankomycin, beroende på svårighetsgrad. Faecestransplantation kan vara aktuellt vid recidiverande C. difficile-infektioner. Kirurgi blir i sällsynta fall aktuellt vid svår och komplicerad C. difficile-infektion.
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  • Bo Svenungsson, docent och överläkare, Smittskydd Stockholm
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet