Factores de riesgo para mortalidad en pacientes con infección por Clostridium difficile / Risk factors for mortality in patients with Clostridium difficile infection

Resumen Introducción: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. Objetivo: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. Método: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). Resultados: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. Conclusiones: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

Abstract Introduction: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. Objective: To identify the risk factors for mortality in hospitalized patients with CDI. Method: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). Results: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. Conclusions: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

Prevalence of Clostridium difficile-associated diarrhoea among hospitalized Jordanian patients

We investigated stool specimens of 400 patients at Jordan University Hospital [300 patients with clinical diarrhoea and 100 controls without diarrhoea] for the presence of Clostridium difficile or its toxin. We found a 9.7% prevalence rate of C. difficile or its toxin in stools of patients with diarrhoea. The prevalence of other potential enteric pathogens, such as Salmonella spp. [2.3%], Shigella spp. [1.0%] and Entamoeba histolytica [2.7%], was significantly less. Prevalence of C. difficile or its toxin in controls was 3.0%. Toxin A was detected in 93.1% of C. difficile-associated diarrhoea cases using an enzyme immunoassay. Our study indicates that C. difficile-associated diarrhoea is mostly observed among hospitalized patients aged > or = 50 years, in association with antimicrobial treatment

Fatores contemporâneos que afetam a incidência de patógenos causadores de doenças de origem alimentar / Contemporary factors that affect the incidence of foodborne pathogens

A modernizaçäo da sociedade e os avanços na tecnologia alimentar resultaram em mudanças na formulaçäo, produçäo e distribuiçäo dos alimentos criando, consequentemente, situaçöes anteriormente imprevistas, que se constituem em novos desafios microbiológicos. Inúmeros fatores inter-relacionados contribuem para agravar o risco de doenças de origem alimentar, dentre os quais se destacam, as inovaçöes na agropecuária, mudanças nos hábitos alimentares e o aumento da suscetibilidade a infecçöes. Esta revisäo focaliza a situaçäo atual das doenças de origem alimentar, considerando os principais agentes, os fatores de risco e a importância da conscientizaçäo da populaçäo para a prevençäo de surtos epidêmicos.

Mionecrosis no traumática por clostridium perfringes: reporte de un caso y revisión de la literatura / Non traumatic myonecrosis for clostridium perfringes: case report

Presentamos el caso de una paciente portadora de un Linfoma Non Hodkin primario del intestino delgado; quien durante la fase inicial de su tratamiento presentó perforación del íleon terminal y ciego y, como consecuencia, un cuadro de mionecrosis no traumática del miembro superior derecho causada por clostridium perfringens. La probable puerta de entrada del organismo fue la necrosis del tumor y la perforación del tracto digestivo producida por la quimioterapia. Es importante tener en mente que existe una interesante asociación entre infecciones gangrenosas no traumáticas por Clostridium y neoplasias malignas del intestino. Se discute el caso y se presenta una revisión de la literatura.

Anaerobes: a preliminary study

The role of anaerobes in causation of infections has been largely ignored due to lack of culture facilities in our country. This study was conducted to assess the significance of anaerobic bacterial infections in our setup. The anaerobes were isolated in pure cultures in 25.6% cases and in mixed cultures in 74.4%. The septic wounds and female genital tract were common sites. Bacteroides spp. and clostidium spp. were the predominant groups isolated