RESUMEN
OBJECTIVE: To review the management of patients with Clostridium difficile-associated diarrhoea (CDAD). METHODS: A retrospective study was conducted on 26 patients with clinical symptoms of CDAD and positive tests for C difficile toxins A and/or B in stool samples, over a 12- month period. Demographic and clinical data on the patients including use of proton pump inhibitors (PPI), management of CDAD, and compliance with local Infection Prevention and Control Guidelines were examined. RESULTS: The majority of patients were over 45 years of age (24/26, 92.4%) and 42% (11/26) were over 80 years of age. At least 50% (13/26) of the patients had acquired CDAD in hospital, 15% (4/26) were community acquired and symptomatic at admission while the onset of diarrhoea following admission to hospital was not documented in 35% (9/26). Three (11%) patients had used PPI. Fifteen per cent (4/26) of patients had no history of previous antibiotic therapy; 40% (10/26) were treated with a cephalosporin, fluoroquinolone or a combination of at least two different classes of antibiotics; one (3%) patient was on augmentin and the antibiotic regime used was not documented in 42% (11/26) who also had previous antibiotic therapy. The conditions for which antibiotics were prescribed could not be ascertained in 58% (15/26) but among the remaining cases antibiotics had been prescribed for urinary tract infection, wound respiratory tract infections and sepsis. Metronidazole (18/26, 70%) was the preferred drug of choice for first line therapy in patients with CDAD. None of the patients in the study received the recommended 10 to 14 days of antimicrobial therapy for CDAD. Recurrent CDAD was observed in 40% of those who were treated with metronidazole. The study also showed that there was timely reporting of laboratory results and good compliance with the hospital Infection Prevention and Control Guidelines. CONCLUSION: The findings of this study can be used as a process improvement measure in the management of patients with CDAD.
Asunto(s)
Antibacterianos/uso terapéutico , Clostridioides difficile , Infección Hospitalaria/prevención & control , Diarrea/tratamiento farmacológico , Diarrea/microbiología , Enterocolitis Seudomembranosa/tratamiento farmacológico , Enterocolitis Seudomembranosa/microbiología , Control de Infecciones/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Adhesión a Directriz , Hospitales Comunitarios , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVES: To review the management of patients with Clostridium difficile-associated diarrhoea (CDAD). METHODS: A retrospective study was conducted on 26 patients with clinical symptoms of CDAD and positive tests for C difficile toxins A and/or B in stool samples, over a 12- month period. Demographic and clinical data on the patients including use ofproton pump inhibitors (PPI), management of CDAD, and compliance with local Infection Prevention and Control Guidelines were examined. RESULTS: The majority ofpatients were over 45 years of age (24/26, 92.4%) and 42% (11/26) were over 80 years of age. At least 50% (13/26) of the patients had acquired CDAD in hospital, 15% (4/26) were community acquired and symptomatic at admission while the onset of diarrhoea following admission to hospital was not documented in 35% (9/26). Three (11%) patients had used PPI. Fifteen per cent (4/26) of patients had no history of previous antibiotic therapy; 40% (10/26) were treated with a cephalosporin, fluoroquinolone or a combination of at least two different classes of antibiotics; one (3%) patient was on augmentin and the antibiotic regime used was not documented in 42% (11/26) who also had previous antibiotic therapy. The conditions for which antibiotics were prescribed could not be ascertained in 58% (15/26) but among the remaining cases antibiotics had been prescribed for urinary tract infection, wound respiratory tract infections and sepsis. Metronidazole (18/26, 70%) was the preferred drug of choice for first line therapy in patients with CDAD. None of the patients in the study received the recommended 10 to 14 days of antimicrobial therapy for CDAD. Recurrent CDAD was observed in 40% of those who were treated with metronidazole. The study also showed that there was timely reporting oflaboratory results and good compliance with the hospital Infection Prevention and Control Guidelines. CONCLUSION: The findings of this study can be used as a process improvement measure in the management of patients with CDAD.
OBJETIVO: Revisar el tratamiento de pacientes con diarrea asociada con Clostridium difficile (DACD). MÉTODO: Se llevó a cabo un estudio retrospectivo de 26 pacientes aquejados por síntomas clínicos de DACD. Dichos pacientes resultaron positivos a pruebas de detección de toxinas A y/o B de C difficile en muestras de heces fecales por un período de 12 meses. Se examinaron los datos demográficos y clínicos de los pacientes, incluyendo el uso de inhibidores de la bomba de protones (IBP), tratamiento de la DACD, y el cumplimiento con las guías para el control de la infección local. RESULTADOS: La mayoría de los pacientes tenían más de 45 años de edad (24/26, 92.4%) y 42% (11/26) estaban por encima de los 80 años de edad. Al menos 50% (13/26) de los pacientes habían adquirido DACD en el hospital; el 15 % (4/26) la adquirió en la comunidad y presentaba síntomas al momento del ingreso; el comienzo de la diarrea tras el ingreso al hospital no se documentó en 35% (9/26) de los casos. Tres pacientes (11%) habían usado IBP. El 15% (4/26) de los pacientes no tenían antecedente alguno de terapia con antibióticos; un 40% (10/26) fue tratado con cefalosporina, fluoroquinolona, o una combinación por lo menos dos clases diferentes del antibióticos; un paciente (3%) se hallaba bajo tratamiento con augmentina y el régimen antibiótico usado no se documentó en el 42% (11/26) de los casos, que también tuvieron terapia antibiótica previa. No pudieron determinarse las condiciones para las que se prescribieron los antibióticos en el 58% (15/26), pero entre los casos restantes, se habían prescrito antibióticos para la infección de las vías urinarias, heridas, infecciones de las vías respiratorias, y sepsis. El metronidazol (18/26, 70%) fue el medicamento de opción preferida para la terapia de primera línea en los pacientes con DACD. Ninguno de los pacientes en el estudio recibió los 10 a 14 días de terapia antimicrobiana, recomendados para la DACD. Se observó DACD recurrente en 40% de aquéllos que fueron tratados con metronidazol. El estudio también mostró que hubo reportes oportunos de resultados de laboratorio y buen cumplimiento de las guías hospitalarias para el control de las infecciones. CONCLUSIÓN: Los hallazgos de este estudio pueden usarse como medida para mejorar el proceso encaminado a tratar a los pacientes con DACD.