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CLINICAL GASTROENTEROLOGY

    1. State Scientifi c Center of Coloproctology, 123423, Moscow, Russia, st. Salam Adil 2
    2. I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, Moscow, Russia
    3. Gamaleya National Research Centre for Epidemiology and Microbiology, Ministry of Public Health, Moscow, Russia

    Keywords: bacteriocins, antagonistic activity, Lactobacilli, Clostridium (Clostridioides) diffi cile, C. diffi cile-associated diarrhea

    Abstract: Aim: to evaluate antagonistic properties of Lactobacilli against clinically relevant Clostridium (Clostridioides) diffi cile strains. Materials and methods: we assessed antagonistic properties of 21 Lactobacilli strains isolated from the patients’colon biotope against 31 clinically relevant C. diffi cile strains isolated from faeces of the patients with C. diffi cile-associated diarrhea by means of a double-step culturing in the combined cultivation system. Results: Lactobacilli strains isolated from the patients’colon biotope had selective antagonistic properties against C. diffi cile. Lactobacilli strains had diff erent spectrum and intensity of antagonistic activity that showed no correlation neither with species, nor with natural population size. We isolated Lactobacilli strains with high antagonistic activity (L. paracasei 101, L. gasseri 341/2, L. paracasei 340/1). We isolated bacteriocins from Lactobacilli cultures. The infl uence of bacteriocins on C. diffi cile strains correlated with antagonistic activity of Lactobacilli; bacteriocins suppressed C. diffi cile growth in dose-dependent manner. Conclusion: evaluation of Lactobacilli antagonistic activity is a prospective approach to struggle against nosocomial infection caused by resistant strains, particularly using Lactobacilli autostrains for suppression of toxigenic C. diffi cile strains growth.

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    Sukhina M. A., Shelygin Yu. A., Zhukhovitsky V. G., Frolov S. A., Kashnikov V. N., Veselov A. V., Lutsenko S. V., Chistyakova D. A. Prospects of using antagonistic activity of lactobacilli to suppress the growth of Clostridium (Clostridioides) diffi cile. Experimental and Clinical Gastroenterology. 2018;160(12): 19–24. (In Russ.) DOI: 10.31146/1682-8658-ecg-160-12-19-24
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    1. Federal State Budgetary Educational Institution of Higher Education “Kazan State Medical University” of the Ministry of Healthcare of the Russian Federation, department of hospital therapy
    2. Kazan State Medical Academy — Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian Federation, central scientifi c research laboratory,
    3. I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991, Moscow, Russia
    4. State Autonomous Healthcare Institution “Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan”, gastroenterology department

    Keywords: infl ammatory bowel disease, ulcerative colitis, Crohn’s disease, Clostridium diffi cile, C. diffi cile

    Abstract: Aim. To evaluate the IgA, IgM and IgG to lipoteichoic acids (LPA) of Clostridium diffi cile (C. diffi cile) in infl ammatory bowel disease (IBD). Materials and Methods. We prospectively included 147 patients with IBD [92 with ulcerative colitis (UC) and 55 with Crohn’s disease (CD)] and 30 healthy volunteers. The concentration of IgA, IgM and IgG to C. diffi cile LPA in blood was determined by enzyme immunoassay method. Results. The level of IgA to LPA of C. diffi cile was higher in active IBD — 0,12 [0,06; 0,19] mkg/ml, p<0,05) and in remission (0,12 [0,07; 0,18] mkg/ml) compared with in control group — 0,009 [0,005; 0,01] mkg/ml. In active CD the studied IgA were higher than in control group (p<0,01). The level of IgM to LPA of C. diffi cile was higher in IBD exacerbation (4,75 [2,48; 7,45 mkg/ml; p<0,001), in remission (4,69 [2,65; 7,85] mkg/ml; p<0,05) than in healthy volunteers (2,4 [1,5; 4,08] mkg/ml; p<0,01). The changes in UC and CD were identical. The studied IgG was higher in active IBD (4,17 [1,34; 6,55] mkg/ml; p<0,0001) and in remission (3,39 [1,42; 5,81] mkg/ml; p<0,01) than in control group (1,0 [0,89; 1,94] mkg/ml). The changes were similar in UC and CD. The levels of studied IgA and IgG in healthcare workers among our control group was higher than in the persons not related to medicine. Conclusions. The levels IgA, IgM and IgG to C. diffi cile LPA in IBD was signifi cant increase compared with in healthy volunteers. The increase of antibodies was characteristic for active and inactive IBD.

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    Abdulganieva D., Mukhametova D., Zinkevich O., Saphina N., Koporulina M., Odintsova A. Humoral immune response to lipoteichoic acids of Clostridium diffi cile in patients with infl ammatory bowel disease. Experimental and Clinical Gastroenterology. 2018;160(12): 25–32. (In Russ.) DOI: 10.31146/1682-8658-ecg-160-12-25-32
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    1. State Scientifi c Center of Coloproctology, 123423, Moscow, Russia, st. Salam Adil, 2

    Keywords: Antibiotic-associated diarrhea, Clostridioides diffi cile, Clostridial colitis, Clostridium perfringens, C. paraputrifi cum, C. tertium, C. novyi, Clostridioides diffi cile is an associated infection

    Abstract: Aim. Determine the etiological structure of antibiotic-associated diarrhea in Russia. Materials and methods. The study included 746 patients in inpatient treatment. 502 patients were examined at the stage of admission and discharge from the hospital, and 305 patients with the clinical picture of Clostridioides diffi cile-associated infection (CDI), among them 163 (46.6%) men and 142 (53.4%) women. The age of the patients was 48–67 years. All patients were examined luminal feces upon admission to the hospital, upon discharge from the hospital and in the case of a clinical picture of CDI. Results. Analysis of the etiological factor of clostridial infection showed that in 253 (83.2%) cases, the causative agent of antibiotic-associated diarrhea was C. diffi cile. Other types of clostridia were found in almost all CDI cases (97.7%). At the same time, C. perfringens remained the dominant type of clostridia in the same way as in patients upon admission to the clinic. The average dissemination of C. diffi cile was higher (p <0.05) compared with the value of the indicator in patients on admission and was 10 * 7 CFU / g; the titer of dissemination with other types of clostridia remained at the level of 10 * 5 CFU / g. — 10 * 7 CFU / g., Median 10 * 6 CFU / g. Analysis of the clinical picture of clostridial colitis revealed its similarity, regardless of the etiologically signifi cant microorganism being detected. In 52 (16.8%) of 305 patients, the clinical picture was due to other members of the genus Clostridium (Clostridium perfringens, C. paraputrifi cum, C. tertium, C. novyi). Also, as with CDI, diarrhea syndrome occurred in 100% of cases, hyperthermia occurred in 82%, fl atulence in 42%, vomiting in 13%, and abdominal pain in 11%. The severity of Clostridium spp. Diarrhea varied widely. So, in 26 (50%) of 52 patients with preserved anal defecation, the median stool frequency was 10 (5; 14) times / day, which is comparable with the data obtained in colitis caused by C. diffi cile. Conclusions. An analysis of the etiological factor in the development of CDI showed that, in addition to the known etiological factor of antibiotic-associated diarrhea — toxigenic C. diffi cile with the leading virulence factor production of toxin B, in 52 (16.9%) cases, other representatives of this genus were an etiological factor of diarrhea (Clostridium perfringens, C. paraputrifi cum, C. tertium, C. novyi). The development of antibiotic-associated diarrhea, caused by representatives of other types of clostridia, must be considered when prescribing therapy for clostridial colitis.

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    Full text is published :
    Achkasov S. I., Sukhina M. A., Sushkov O. I., Frolov S. A., Kashnikov V. N., Safi n A. L., Veselov A. V., Shelygin Yu. A. Etiological structure of antibiotic-associated diarrhea in patients with large intestine diseases. Experimental and Clinical Gastroenterology. 2018;160(12): 33–39. (In Russ.) DOI: 10.31146/16828658-ecg-160-12-33-39
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    1. State Scientifi c Center of Coloproctology, 123423, Moscow, Russia, st. Salam Adil, 2
    2. Federal state budgetary educational institution additional professional education Ministry of Health of Russia, 125993, Moscow, Russia, st. Barrikadnaya, d. 2⁄1, p. 1

    Keywords: Clostridioides diffi cile, antibiotic-associated diarrhea, Clostridioides diffi cile — associated infection, antibiotic resistance, vancomycin, metronidazole, fi daxomycin

    Abstract: Aim. To study the distribution of Clostridioides diffi cile strains resistant to antibacterial drugs in patients with antibiotic-associated diarrhea. Materials and methods. The study included 102 strains of Clostridioides diffi cile, isolated from 118 patients with a clinical picture of antibiotic-associated diarrhea. Isolation and identifi cation of microorganisms was carried out by standard bacteriological methods. Results. Of the total number of isolated strains of C. diffi cile, 7.6% were resistant to vancomycin and metronidazole. 21.9% of C. diffi cile strains were resistant to metronidazole. The level of resistance to vancomycin in strains isolated from patients with antibiotic-associated diarrhea, according to our data, has increased from 4% to 9.6% over the past 2 years. More than half of C. diffi cile strains (51.3%) were resistant to rifaximin. 2 strains of C. diffi cile were resistant to fi daxomycin. Conclusions. The analysis of C. diffi cile resistance to the main drugs recommended as etiotropic therapy for clostridial colitis showed that it was 9.6% for vancomycin and 21.9% for metronidazole in a Russian coloproctology hospital. The obtained data confi rm the need to monitor the spread of resistance among strains of C. diffi cile, the etiological factor of antibiotic-associated infection.

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      2. Sekacheva. M. I. Antibiotic-associated diarrhea. Consilium Medicum. Gastroenterology. 2007; 02: 39–42.
      3. Shulpenkova Yu. O. Russkij medicinskij zhurnal. 2007, vol.15, no.6, pp.1–6 (in Russian).
      4. Uspenskiy Yu.P., Fominykh Yu. A. Antibiotic-associated diarrhea: actuality of the problem, prevention and therapy. Th e Russian Archives of Internal Medicine. 2013;(2):46–53. (In Russ.) https://doi.org/10.20514/2226– 6704–2013–0–2–46–53
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    Sukhina M. A., Shelygin Yu. A., Frolov S. A., Safin A. L. The spread of antibiotic-resistant strains of Clostridioides diffi cile in patients with antibiotic- associated diarrhea. Experimental and Clinical Gastroenterology. 2018;160(12): 40–46. (In Russ.) DOI: 10.31146/1682-8658-ecg-160-12-40-46
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    1. State Scientifi c Center of Coloproctology, 123423, Moscow, Russia, st. Salam Adil, 2
    2. Federal state budgetary educational institution additional professional education Ministry of Health of Russia, 125993, Moscow, Russia, st. Barrikadnaya, d. 2⁄1, p. 1

    Keywords: Clostridium (Clostridioides) diffi cile, lactobacilli, transplantation of intestinal microbiota

    Abstract: AAim: to imply a method of Clostridium (Clostridioides) diffi cile-associated infection treatment based on lactobacilli autostrains. Materials and methods: Toxin-producing vancomycin-resistant C. diffi cile and three types of lactobacilli in diff erent titers were isolated from the translucent feces of a patient with recurrent C. diffi cile-associated infection. According to the results of the study, the strain Lactobacillus zeae was detected, which showed high antagonistic activity against C. diffi cile. Within 48 hours, biomass of L. zeae was accumulated. The patient was administered a suspension of lactobacilli per rectum (in the form of microclysters) every other day. Results: in a patient with severe pseudomembranous colitis, a persistent remission of the underlying disease was achieved against the background of regular injections of a suspension of Lactobacillus zeae autostrains with a high antagonistic activity against C. diffi cile, isolated in this patient. Conclusion: Lactobacillus transplantation is an eff ective and promising treatment for recurrent clostridial infection resistant to antibiotic therapy.

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    Full text is published :
    Belous S. S., Sukhina M. A., Halif I. L., Kashnikov V. N., Veselov A. V., Shelygin Yu. A. The first experience of successful treatment of pseudomembranous colitis with lactobacilli auto-strains. Experimental and Clinical Gastroenterology. 2018;160(12): 47–50. (In Russ.) DOI: 10.31146/1682-8658-ecg-160-12-47-50
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    1. State Scientifi c Center of Coloproctology, 123423, Moscow, Russia, st. Salam Adil, 2
    2. Federal state budgetary educational institution additional professional education Ministry of Health of Russia, 125993, Moscow, Russia, st. Barrikadnaya, d. 2⁄1, p. 1

    Keywords: Clostridioides diffi cile, antibiotic-associated diarrhea, fecal microbiota, Clostridioides diffi cile-associated infection

    Abstract: Aim. Study of the dynamics of changes in the intestinal microbiota of patients with Clostridioides diffi cile-associated infection. Materials and methods. The study included 746 patients in inpatient treatment. 502 patients were examined at the stage of admission and discharge from the hospital, and 305 patients with the clinical picture of Clostridioides diffi cile-associated infection (CDI), among them 163 (46.6%) men and 142 (53.4%) women. The age of the patients was 48–67 years. The qualitative and quantitative composition of translucent feces was investigated. Results. Analysis of the study of the qualitative and quantitative composition of the fecal microbiota of patients treated in a coloproctology hospital and patients with a clinical picture of Clostridioides diffi cile-associated infection showed the dynamics of changes in the colonic microbiota in patients upon admission to hospital and the development of the clinical picture of antibiotic-associated diarrhea. Upon admission to the hospital, patients with diseases of the colon showed a decrease in the titer of lactobacilli (median 10 * 5 CFU / g., Fluctuation range 10 * 4 CFU / g; 10 * 6 CFU / g). With colitis caused by Clostridioides diffi cile and other members of the genus Clostridium spp., A signifi cant decrease in the amount of lactobacillus in the luminal feces was observed (p <0.01). There were no signifi cant diff erences in the level of contamination of the luminal feces with enterobacteria in all groups of patients examined. Conclusions. Development of CDI is characterized by a pronounced decrease auhtonnoy microfl ora, especially lactobacilli. The degree of microbiota changes in patients with CDI is ambiguous for each member of the microbial community of colonic microbiocenosis.

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    Full text is published :
    Sukhina M. A., Shelygin Yu. A., Lyagina I. A., Frolov S. A. Features of fecal microbiotes of Clostridioides diffi cile-associated infection. Experimental and Clinical Gastroenterology. 2018;160(12): 51–57. (In Russ.) DOI: 10.31146/1682-8658-ecg-160-12-51-57
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