Study On The Diagnosis And Treatment Of Clostridium Difficile - Related Diarrhea

Clostridium difficile associated diarrhea(CDAD) results from abnormally excessive proliferation of Clostridium difficile from the gut, releasing toxins caused by diarrhea as the main manifestation of infectious diseases. With different degrees of clinical symptoms, the light CDAD showed only mild to moderate diarrhea, while serious CDAD can be manifested as severe or fatal fulminant pseudomembranous colitis. CDAD was first reported in 1978 and considered to be associated with the application of antibiotics. With the widespread use of broad-spectrum antibiotics, the CD AD mortality and morbidity have been rising worldwide, and become the most important reason for nosocomial infection. Along with the emergence of new toxigenic strains, CDAD of children has been increasing. The characteristics of Clostridium difficile include easy resistance to medicine, long survival time outside, and strong propagation, which lead to outbreaks in hospitals and health care facilities. At present, antibiotics, mainly metronidazole and vancomycin are used to treat CDAD, but there are side effects such as destruction of beneficial intestinal flora, high recurrence rate. CDAD treatment is facing serious challenges due to obvious increase of its recurrence and mortality.Clinical observation and experimental studies show that traditional Chinese medicine(TCM) has certain advantages in treating CDAD. Vitro experiments found that traditional Chinese medicine can inhibit the reproduction and expression of Clostridium difficile toxin, adjust the balance of flora, and protect and repair intestinal mucous membrane barrier of bacteria, mechanical barrier and immune barrier. Traditional Chinese medicine based its understanding of CDAD on antibiotic associated diarrhea(AAD). Most clinical observations or experimental researches have not conducted Clostridium difficile pathogen detection, but about 25 to 33% of the AAD and almost all pseudomembranous colitis were related to Clostridium difficile, therefore AAD is generally regarded as a synonym of CDAD. According to its main clinical manifestations, CDAD is categorized as "diarrhea" in traditional Chinese medicine. Through long-term clinical practice, this study concluded, the internal factor is that the imbalance of intestinal flora resulted in CDAD, the external factor is the invasion and valuation of Clostridium difficile. Spleen deficiency and damp abundance is the main cause of CDAD.Traditional Chinese medicine is effective in treating CD AD, but it is short of unified standards. Most doctors practice out of their experiences instead of objective evidence and their diagnosis and prescriptions have no theoretical basis. In this study, literatures of both traditional Chinese medicine and integrated traditional Chinese and Western medicine in treating CD AD, published in the past 10 years, were collated and analyzed in order to explore and study the diagnosis and prescription laws in treating CD AD by TCM doctors, in order to provide reference for clinical treatment of CDAD. We searched CNKI, WanFang, VIP, CBM and other databases from 2007 to 2016. Random and comparative clinical studies of TCM and integrated TCM and Western medicine in treating CDAD were collected. According to the inclusion and exclusion criteria,31 documents were selected to establish a TCM database by using Microsoft Excel. We conducted statistical analysis of the therapeutic principle including frequency of use, efficacy, potency, taste of a single herb. Results:in the 31 documents, there are 15 treatment methods,35 prescriptions and 79 kinds of herbs.52% were related to strengthening Spleen, invigorating Qi and removing dampness. From frequency of use of herbs in treating CDAD, atractylodes, licorice, codonopsis, Chinese yam, white beans were chosen to strengthen Spleen and invigorating Qi; Poria Cocos and Coix seeds were chosen to induce diuresis and eliminate dampness; Fructus amomi and Herb were chosen to remove dampness, activate Yang-energy and stop diarrhea. In treating CDAD, drugs which strengthen Spleen, induce diuresis and eliminate dampness are more frequently used, accounting for 53.6%. From the point of view of drug potency, potency is warm, flat drugs accounted for 65.7%, which is the main treatment of CDAD medications. As for the smell and taste, sweet and bitter drugs account for 59.5%. In summary, drugs associated with treating spleen, stomach and lung account for 60.4% of all drugs used in treating CDAD. The results suggest that, the key location in treating CDAD is in the spleen and lung, which is consistent with the etiology and pathogenesis of CDAD.This study conducted a systematic analysis of the treatment methods and principles of traditional Chinese medicine in treating CDAD and provided a useful idea in preventing and treating CDAD. The study will be of use for relevant researches and experiments and ultimately help to improve prevention and treatment of CDAD.