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La infección por Clostridium difficile (ICD) ha aumentado su incidencia en los últimos años, convirtiéndose en una de las infecciones más comunes adquiridas en el ámbito hospitalario, causando una diarrea infecciosa que está fuertemente asociada al uso de antibióticos. En la actualidad, los antibióticos para su tratamiento son la vancomicina oral y fidaxomicina, siendo la vancomicina oral la más coste-efectiva para el Sistema Nacional de Salud.Se describe el caso de una paciente pluripatológica sometida a dos sesiones de hemodiálisis semanales, que es diagnosticada de ICD evolucionada a colitis pseudomembranosa confirmada por endoscopía. Se inició tratamiento para la ICD con una fórmula magistral de vancomicina oral a una dosis de 250 mg cada 6 horas. La terapia con vancomicina oral no fue efectiva ni segura en la paciente, produciéndose una absorción sistémica significativa de vancomicina llegando a concentraciones plasmáticas de 15,57 mcg/mL. Fueron necesarios 8 días para completar la eliminación de la vancomicina, durante los cuales la paciente se sometió a 4 sesiones de hemodiálisis.El caso descrito pone de manifiesto la necesidad de monitorizar las concentraciones plasmáticas de vancomicina durante el tratamiento de ICD, especialmente en pacientes con elevadas dosis de fármaco, con insuficiencia renal y afectación de la integridad del tracto gastrointestinal. (AU)

Clostridium difficile infection (CDI) has increased its incidence in recent years, becoming one of the most common infections acquired in the hospital setting, causing an infectious diarrhea that is strongly associated with the use of antibiotics. Currently, the antibiotics used for this treatment are oral vancomycin and fidaxomycin, being oral vancomycin the most cost-effective for the National Health System.We describe the case of a pluripatological patient who underwent two weekly hemodialysis sessions, which is diagnosed as having developed CDI to pseudomembranous colitis confirmed by endoscopy. Treatment for CDI was initiated with a master formula of oral vancomycin at a dose of 250 mg every 6 hours. Oral vancomycin therapy was not effective and safe in the patient, resulting in significant systemic absorption of vancomycin reaching plasma vancomycin concentrations of 15.57 mcg/mL. It took 8 days to complete the elimination of vancomycin, during which the patient underwent 4 hemodialysis sessions.The described case highlights the need to monitor vancomycin plasma concentrations during the treatment of CDI, especially in patients with high doses of drug, with renal insufficiency and impairment of the integrity of the gastrointestinal tract. (AU)

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BACKGROUND: A measles outbreak which started in the technical institute Els Ports in Albocacer (Castellón), and involved nearby towns was studied. METHODS: The outbreak was described using a retrospective cohort study to estimate the efficacy of the antimeasles vaccination (EV) by a questionnaire distributed in the institute. Response rate was 80.7%. A clinical definition of measles was used with EV being calculated by 2 different formulas. Antimeasles vaccination coverage (VC) in primary schools of the towns involved was also assessed. RESULTS: The outbreak occurred from February to April 1992, including 13 cases of measles (mean age: 13.6 +/- 2.7 years). Eleven patients (84.6%) had not been vaccinated. The attack rate the above mentioned institute was 9.1% (8 cases/88 students) with VC of 40.9%. An association was found only between being vaccinated and not having measles, relative risk 0.07 (confidence limits [CL] 95%: 0.01-0.50). EV was 92.9% (CL 95%: 50-99%) using the traditional formula and 96.2% (CL 95%: 88.2-100%) using the new formula. The VC in the schools was 92.3%. Vaccination with the triple viral vaccine was recommended to susceptible individuals. CONCLUSIONS: Despite specific vaccination measles continues to produce epidemics. A second dose of the triple viral vaccine is recommended for being included in the vaccination calendar between the age of 6 and 14 years.

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