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Colegio de Medicina Interna de México.

2018, Number 1

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Med Int Mex 2018; 34 (1)

Diarrhea due to Clostridium difficile in hospitalized patients

Martínez-Rodríguez AA, Estrada-Hernández LO, Tomé-Sandoval P, Salazar-Salinas J

Language: Spanish
References: 24
Page: 9-18
PDF size: 328.00 Kb.


ABSTRACT

Background: Infection due to Clostridium difficile is the most important cause of gastrointestinal disease related to the hospitality system leading to high morbidity and mortality and costs estimated in 3.2 billion dollars each year.
Objective: To know the behavior of intrahospitalary diarrhea due to C. difficile, as well as the characteristics of the disease and patients.
Material and Method: A longitudinal study done from July 1st 2015 to April 30 2016, in which cases of intrahospitalary diarrhea attended in all services of the Reginal Hospital Lic. Adolfo López Mateos, Mexico City, were included. With the support of the Laboratory of Epidemiological Surveillance of ISSSTE, at Centro Médico Nacional 20 de Noviembre, Mexico City, all cases were submitted to immunoassay test to the identification of toxins A, B or both.
Results: There were identified 220 cases of intrahospitalary diarrhea in the study period, from which 106 (48.2%) were positive to immunoassay test for toxins A, B (or both) of C. difficile and corresponded to services of Internal Medicine, General Surgery and Intensive Care Unit. One hundred patients were followed, from which 75 were discharged and 25 died (mortality rate of 25%). Service in which most cases were identified was Internal Medicine with 58 (54.7%), followed by General Surgery with 14 (13.2%) and Orthopedics with 10 (10.6%). The 106 patients included that resulted positive had received during their hospitalization and before presenting diarrhea at least one antimicrobial, 41.4% monotherapy and 58.6% two or more antimicrobials. The most frequently prescribed antibiotic in cases of monotherapy was ceftriaxone (50%), followed by meropenem (20.6%) and in all cases of combinations it was observed a variety of them. The mean days of hospitalization of patients who died was of 24 days (range: 5-112) and of discharged patients was of 20 days (range: 2-85).
Conclusions: This study gives information very similar to that reported in the little Mexican publications referred in this paper about risk factors, variability of clinical manifestations, opportunity of treatment, evidence, consequences of the indiscriminate administration of antibiotics with prophylactic and/or therapeutic objectives and the need of multidisciplinary treatment of patients with severe disease. It is also highlighted the participation of H2 blockers as an important risk factor found in more than 70% of cases and the administration of mesalazine and probiotics as adjuvant in the treatment.


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