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Acute infectieuze diarree (AID)

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Virussen als verwekkers van AID

Beoordeeld: 01-02-2014

Norovirussen veroorzaken doorgaans milde AID met een selflimiting karakter bij verschillende leeftijdsgroepen. Bij ouderen en bij personen met een onderliggende ziekte kan de ziekte ernstiger verlopen. Transmissie van virale verwekkers van AID vindt voornamelijk plaats van mens naar mens, hoewel bij norovirussen transmissie in belangrijke mate verloopt via consumptie van met fecaliën besmet voedsel en drinkwater. Dit leidt met enige regelmaat tot epidemiën in instellingen en op cruiseschepen.[18; 19] Voorts wordt melding gemaakt van frequente uitbraken op geriatrische afdelingen van Nederlandse ziekenhuizen. Net als bij rotavirus geldt dat slechts ondersteunende therapie mogelijk is. Rotavirus is een belangrijke verwekker van ernstige diarree bij jonge kinderen, maar ook bij (immuungecompromitteerde) volwassenen kan dit virus ziekte veroorzaken. Rotavirussen kunnen ook opgepikt worden tijdens het reizen naar tropische bestemmingen en zo in Nederland voor epidemische verheffingen zorgen.

Hoewel het aandeel van virale verwekkers bij het veroorzaken van ernstige diarree bij volwassenen als klein werd ingeschat, laat een recente Nederlandse studie zien dat met name rotavirussen relatief vaak kunnen worden aangetroffen in feces monsters van patiënten die met diarree in een ziekenhuis worden opgenomen.[20] In 41 feces monsters van 45 volwassen patiënten met diarree werd bij 13/41 (32%) patiënten een virus aangetroffen, waarbij het bij 9/41 (22%) patiënten ging om rotavirus.

Onderbouwing

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  264. 264 - 262 Dupont HL, Ericsson CD, Mathewson JJ, DuPont MW. Five versus three days of ofloxacin therapy for traveler's diarrhea: a placebo-controlled study. Antimicrob Agents Chemother 1992;36:87-91.
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  267. 267 - 265 Ericsson CD, Dupont HL, Mathewson JJ. Single Dose Ofloxacin plus Loperamide Compared with Single Dose or Three Days of Ofloxacin in the Treatment of Traveler's Diarrhea. J Travel Med 1997;4:3-7.
  268. 268 - 266 Isenbarger DW, Hoge CW, Srijan A et al. Comparative antibiotic resistance of diarrheal pathogens from Vietnam and Thailand, 1996-1999. Emerg Infect Dis 2002;8:175-180.
  269. 269 - 267 Vlieghe ER, Jacobs JA, Van EM, Koole O, Van GA. Trends of norfloxacin and erythromycin resistance of Campylobacter jejuni/Campylobacter coli isolates recovered from international travelers, 1994 to 2006. J Travel Med 2008;15(6):419-425.
  270. 270 - 268 Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis 1998;26:341-45.
  271. 271 - 269 Hakanen A, Kotilainen P, Huovinen P, Helenius H, Siitonen A. Reduced fluoroquinolone susceptibility in Salmonella enterica serotypes in travelers returning from Southeast Asia. Emerg Infect Dis 2001;7:996-1003.
  272. 272 - 270 Gibreel A, Taylor DE. Macrolide resistance in Campylobacter jejuni and Campylobacter coli. J Antimicrob Chemother 2006;58:243-55.
  273. 273 - 271 Luangtongkum T, Shen Z, Seng VW et al. Impaired fitness and transmission of macrolide-resistant Campylobacter jejuni in its natural host. Antimicrob Agents Chemother 2012;56:1300-08.
  274. 274 - 272 Tham J, Odenholt I, Walder M, Brolund A, Ahl J, Melander E. Extended-spectrum beta-lactamase-producing Escherichia coli in patients with travellers' diarrhoea. Scand J Infect Dis 2010;42:275-80.
  275. 275 - 273 Hakanen A, Jousimies-Somer H, Siitonen A, Huovinen P, Kotilainen P. Fluoroquinolone resistance in Campylobacter jejuni isolates in travelers returning to Finland: association of ciprofloxacin resistance to travel destination. Emerg Infect Dis 2003;9:267-70.
  276. 276 - 274 Ericsson CD, Dupont HL, Mathewson JJ, West MS, Johnson PC, Bitsura JA. Treatment of traveler's diarrhea with sulfamethoxazole and trimethoprim and loperamide. JAMA 1990;263:257-61.
  277. 277 - 275 Taylor DN, Sanchez JL, Candler W, Thornton S, McQueen C, Echeverria P. Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial. Ann Intern Med 1991;114(9):731-734.

Er zijn voor deze richtlijn geen evidence tabellen opgesteld.

Autorisatiedatum en geldigheid

Laatst beoordeeld  : 01-02-2014

Laatst geautoriseerd  : 01-02-2014

Geplande herbeoordeling  :

De geldigheid van de richtlijn is 5 jaar; in 2019 of zoveel eerder als nodig is zal de richtlijn ge-reëvalueerd worden.

Initiatief en autorisatie

Initiatief:
  • Stichting Werkgroep Antibioticabeleid

Algemene gegevens

De richtlijn is opgesteld en goedgekeurd door vertegenwoordigers van de in de inleiding en methoden genoemde beroepsverenigingen, en verwoordt de geldende professionele standaard in februari 2014. De richtlijn bevat aanbevelingen van algemene aard. Het is mogelijk dat deze aanbevelingen in een individueel geval niet van toepassing zijn. De toepasbaarheid van de richtlijn in de praktijk is de verantwoordelijkheid van de behandelend arts. Er kunnen zich feiten of omstandigheden voordoen waardoor, in het belang van een goede zorg voor de patiënt, afwijking van de richtlijn wenselijk is.

 

De totstandkoming van deze richtlijn werd gefinancierd door subsidie van het Ministerie van VWS/RIVM-CIb aan de SWAB.

Doel en doelgroep

Doel

De Stichting Werkgroep Antibioticabeleid (SWAB) ontwikkelt richtlijnen voor het gebruik van antibiotica bij volwassenen in het ziekenhuis met als doel het antibioticabeleid te optimaliseren en zo een bijdrage te leveren aan de beheersing van kosten en resistentieontwikkeling.

 

Doelgroep

De richtlijnen dienen als raamwerk voor de commissies die antibioticaformularia opstellen in ziekenhuizen.

Samenstelling werkgroep

Voorbereidingscommissie:

  • Mw. drs. J.C. Bos (internist-infectioloog)
  • Mw. dr. C. Schultsz (arts-microbioloog)
  • Dr. T. Van Gool (arts-microbioloog, parasitoloog)
  • Drs. M. P. Bauer (internist-infectioloog)
  • Prof. dr. J.M. Prins (internist-infectioloog)

 

Wij zijn dank verschuldigd aan mevr. Heleen Dyserinck, (voormalig) bibliothecaresse van de Medische Bibliotheek van het AMC voor haar bijdrage aan de tot stand koming van de zoekstrategie.

Belangenverklaringen

De leden van de voorbereidingscommissie hebben de volgende potentiële belangenconflicten gemeld: M. Bauer heeft op uitnodiging van Astellas een Clostridium-symposium bezocht in Londen, UK. De overige auteurs hebben gemeld geen belangenconflicten te hebben.

Methode ontwikkeling

Evidence based

Werkwijze

Tabel 1. Methodologische kwaliteit van individuele studies [2]

Classificatie

Definitie

A1

A2

Systematische review obv tenminste twee onafhankelijke A2 studies

Randomised Controlled Trial (RCT) van voldoende methodologische kwaliteit en power

of

Prospectieve cohort studie met voldoende power en adekwate correctie voor confounders

B

Vergelijkende studie zonder de methodologische kwaliteit zoals genoemd bij A2 (inclusief patient gecontroleerde studies en cohort studies)

of

Prospectieve cohort studie zonder de methodologische kwaliteit zoals genoemd bij A2, retrospectieve cohort studie of patient gecontroleerde studie

C

Niet vergelijkende studie

D

Bewijs obv de mening van leden van de richtlijn commissie

* NethMap/ISIS surveillance data zijn niet goed te graderen omdat geen gebruik gemaakt kan worden van levels of evidence zoals gebruikt in deze richtlijn. Er wordt echter wel veel gewicht aan de methodologische kwaliteit van deze data toegekend, omdat ze betrekking hebben op zo’n 30% van de Nederlandse bevolking. Ditzelfde geldt voor de MARAN data.

 

Tabel 2. Bewijsniveaus

Bewijsniveaus

Definitie

Niveau 1

Één A1 studie of tenminste twee onafhankelijke A2 studies

Niveau 2

Één A2 studie of tenminste twee onafhankelijke B studie

Niveau 3

Één B of C studie

Niveau 4

Expert opinion

Zoekverantwoording

Zoekacties zijn opvraagbaar. Neem hiervoor contact op met de Richtlijnendatabase.

Volgende:
Bacteriën als verwekkers van AID