Nutritional support in the complex therapy of clostridial infection after surgery

Abstract

In a clinical case we can see the tactics of nutritional support in a patient with pseudomembranous colitis after repeated consecutive operations on the abdominal organs, which led to significant violations of the nutritional status. Nutritional status was assessed using traditional methods: determination of anthropometric parameters (shoulder circumference (OC), thickness of the skin-fat fold over the triceps (TSA)), assessment of clinical and biochemical blood tests. The main aim of demonstrating a clinical case is to show the significance, timeliness, and adequacy of nutritional support in the complex therapy of Clostridium difficile infection. Competent, individually selected correction of protein-energy deficiency in patients with pseudomembranous colitis allows achieving an effective treatment result, avoiding severe complications such as perforation, toxic dilatation, and bleeding. The peculiarity of this clinical case is that a patient with perforation of Meckel's diverticulum and abdominal abscess developed a complication - secondary widespread peritonitis, phlegmon, which required repeated surgical interventions. Surgical treatment and massive antibiotic therapy led to the development of Clostridium difficile infection, during the treatment the patient developed multiple loose stools and Clostridium difficile toxins A and B were detected. Severe pseudomembranous colitis was accompanied by protein-energy deficiency (hypoproteinemia, hypoalbuminemia), severe dehydration, hypokalemia, hyponatremia, and moderately severe anemia of complex genesis. When selecting nutritional support for patients with clostridial infection, it is important to take into account severe systemic inflammation, which affects the absorption and absorption of the intestinal wall, which in turn determines the route of introduction of nutrient substrates. In this case we need to choose the right method for correcting the nutritional status.