Журнал инфектологии (Dec 2021)
Antibiotic-associated colitis in patients with COVID-19 – from imaging to diagnosis
Abstract
The purpose of the study. To identify the main CT signs of colon inflammatory in patients with COVID-19, to correlate the detected signs with clinical manifestations and therapy, as well as to assess the validity of prescribing antibacterial therapy in accordance with Temporary guidelines for the treatment of coronavirus infection.Materials and methods. The data of CT scans of the chest and medical records were analyzed in 30 patients with confirmed coronavirus infection, in whom changes in the colon wall appeared in dynamics at the scanning level during CT. Laboratory data indicators, prescribed therapy, the presence of combined diseases were evaluated.Results. According to CT data, in dynamics in all patients – circular thickening of the colon wall with loss of gaustration, thickening of the submucosal layer in 63,3%, in 93,3% – edema of paracolic fiber. Shifts in the laboratory parameters were noted at admission: leukocytosis in 16.6%, an increase in procalcitonin in 13,3%; leukocyturia, bacteriuria – in 20%. None of the patients had indications of abdominal symptoms at admission, in dynamics at least one abdominal/dyspeptic symptom appeared in 76,6%. Fecal analysis for C.difficile toxins was taken in 50% patients, in 60% the result is positive. All patients were prescribed antibiotics and other therapy in the first 1–3 days of hospitalization. In 53,3%, levofloxacin (per os) was prescribed in combination with protected generation III cephalosporin (intravenously).Conclusions. Shifts in colon with C.difficile colitis in patients with COVID-19 according to CT data are highly likely to reflect the appearance of a pathological process and necessarily require a conclusion. There was a fact of irrational prescription of antibacterial therapy. Clear criteria for prescribing antibiotics against the background of immunosuppressive therapy are needed.
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