Postantibiotic Diarrhoea Caused by Clostridium Difficile in Eldery and Polymorbid Patients - Serious Problem of Primary Care

Pulmonary, urinary, and surgical wounds´ infections are frequent complications during hospitalisation on Medicine and Surgical Departments. Immobilisation, malnutrition, immunodeficiency, diabetes mellitus, elder age, the use of urinary catheters, and chemotherapy belong to the predisposing factors of infectious complication. Subsequent antibiotic treatment can result to the resistance of pathogens and the adverse effects of used drugs. Diarrhoea caused by Clostridium difficile (CD) toxins has to be taken seriously mainly in elderly polymorbid patients due to severe complications like dehydration and metabolic disruption.The treatment of  Clostridium enterocolitis (CE) is complicated by the development of  first-line treatment resistance. Deficiently treated patients can become asymptomatic CD carriers mainly in nursing homes. The prevention of CE development, its relapses, and grave clinical complications could compress the length of hospitalisation and reduce costs.The CE incidence on the Long-term Ill Department within the 13 months (9/2008-9/2009) was analysed in the study. The faeces samples for CD toxins were tested in every patient with diarrhoea. The CE diagnosis was confirmed in 28 patients (10.1%) from total 275 included (mostly immobile people) during hospitalisation. Combined antibiotic therapy seems to be the risk factor for metronidazol resistance as a first-line treatment.These patients after discharge become out-patient in surrounding of their home or in nursing house. General practitioners has to cope with problem. Accent is on rational antibiotic prescription, adhere to hygienic rules and preventive use of probiotics. These arrangements can decrease morbidity, mortality in elderly and polymorbid individuals and brings economic cost.