Gualtero Sandra Milena, Abril Lina Alejandra, Camelo Nathalia, Sanchez Susi Daniela, Davila Fabián Antonio, Arias Gerson, Silva Edwin, Bustos Ingrid Gissel, Josa Diego Fernando, Torres Isabel Cristina, Zambrano Luis Carlos, Pareja María José
Grupo de Infectología y Laboratorio, Fundación Clínica Shaio, Bogotá, D.C., Colombia.
Biomedica. 2017 Dec 1;37(4):466-472. doi: 10.7705/biomedica.v37i4.3244.
Clostridium difficile is the main pathogen related to healthcare-associated diarrhea and it is the cause of 20 to 30% of diarrhea cases caused by antibiotics. In Colombia and Latin America, the knowledge about the epidemiological behavior of this infection is limited.
To describe the characteristics of a series of patients with C. difficile infection.
We performed a descriptive case series study of patients with C. difficile infection hospitalized in the Fundación Clínica Shaio from January, 2012, to November, 2015.
We analyzed 36 patients. The average age was 65 years. The risk factors associated with the infection were: previous use of antibiotics (94.4%), prior hospitalization in the last three months (66.7%) and use of proton pump inhibitors (50%). The most common comorbidities were chronic kidney disease (41.7%) and diabetes mellitus (30.6%). The most frequent symptoms were more than three loose stools per day (97.1%) and abdominal pain (42.9%). According to the severity of the disease, 44.4% of cases were classified as mild to moderate, 38.9% as severe, and 11.1% as complicated or severe. The detection of the toxin by PCR (GeneXpert) was the most common diagnostic procedure (63.8%). Global mortality during hospitalization was 8%. We identified four strains with serotype NAP1/027 and nine samples positive for binary toxin.
Clostridium difficile infection should be suspected in patients with diarrhea and traditional risk factors associated with this disease. We report the circulation of the hypervirulent strain serotype NAP1/027 in Colombia, which should be countered with epidemiological surveillance and a prompt diagnosis.
艰难梭菌是与医疗保健相关腹泻的主要病原体，由抗生素引起的腹泻病例中有20%至30%是由它导致的。在哥伦比亚和拉丁美洲，关于这种感染的流行病学行为的了解有限。
描述一系列艰难梭菌感染患者的特征。
我们对2012年1月至2015年11月在沙约临床基金会住院的艰难梭菌感染患者进行了描述性病例系列研究。
我们分析了36例患者。平均年龄为65岁。与感染相关的危险因素有：既往使用抗生素（94.4%）、过去三个月内曾住院（66.7%）以及使用质子泵抑制剂（50%）。最常见的合并症是慢性肾病（41.7%）和糖尿病（30.6%）。最常见的症状是每天腹泻超过三次（97.1%）和腹痛（42.9%）。根据疾病严重程度，44.4%的病例被分类为轻度至中度，38.9%为重度，11.1%为复杂或重度。通过PCR（GeneXpert）检测毒素是最常见的诊断方法（63.8%）。住院期间的总体死亡率为8%。我们鉴定出四株NAP1/027血清型菌株和九个二元毒素阳性样本。
对于有腹泻且伴有与该疾病相关传统危险因素的患者，应怀疑艰难梭菌感染。我们报告了高毒力血清型NAP1/027菌株在哥伦比亚的传播情况，应通过流行病学监测和及时诊断加以应对。
