Colite associada ao uso de antibióticos e infecção por Clostridioides difficile: Desafios diagnósticos e avanços terapêuticos no ambiente hospitalar.

Abstract

Introduction: Antibiotic-associated colitis represents an important complication in the hospital setting, with Clostridioides difficile infection being the leading cause of this condition. Antibiotic-induced disruption of the intestinal microbiota favors colonization and proliferation of the pathogen, which may result in clinical manifestations ranging from mild diarrhea to severe forms such as pseudomembranous colitis, toxic megacolon, and sepsis. Diagnosis remains challenging, mainly due to the difficulty in distinguishing asymptomatic colonization from active infection and the limitations of available laboratory methods. Objective: To analyze the main diagnostic challenges and recent therapeutic advances related to antibiotic-associated colitis, with emphasis on Clostridioides difficile infection in the hospital context. Methodology: This is an integrative literature review conducted through searches in PubMed/MEDLINE, SciELO, and LILACS databases, using descriptors related to C. difficile infection, diagnosis, treatment, and hospital environment. Studies published within the last 15 years, in English or Portuguese, were included, encompassing international guidelines, clinical trials, systematic reviews, and meta-analyses. A total of 25 articles composed the final sample. Conclusion: The findings demonstrate thatcombined diagnostic algorithms increase accuracy and prevent overdiagnosis. Regarding therapeutic management, oral vancomycin and fidaxomicin have been consolidated as first-line treatments, while adjunctive strategiessuch as bezlotoxumab and fecal microbiota transplantation stand out in recurrent cases. Furthermore, the rational use of antimicrobials and the adaptation of international recommendations to the reality of public hospitalsare essential to reduce morbidity, recurrence, and the healthcare burden of the disease.