RESUMO
To study the association between detection of the Clostridioides difficile gene encoding the binary toxin (CDT) and direct detection of toxinB (TcdB) from feces with the appearance of serious disease, complications, or recurrence in a prospective series of cases. A total of 220 confirmed cases were included, using a two-step algorithm: an initial study to detect the enzyme, glutamate dehydrogenase (GDH), followed, in cases of positivity, by detection of the tcdB. tcdB-positive patients were investigated for the presence of CDT and TcdB. Outcome variables were severe disease, the modified Illinois C. difficile infection (CDI) prognostic risk index (ZAR score), the appearance of complications (need for colectomy, CDI-related death, or toxic megacolon) and recurrence. Patients who tested positive for the presence of TcdB in feces were found to have greater disease severity than those who tested negative, with a ZAR score of 35.4% vs. 23% (p = .048), a higher recurrence rate (14.6% vs. 5.9%, p = .032), and a tendency for higher number of complications (20.7% vs. 11.5%), although without reaching statistical significance (p = .053). When presence of CDT was analyzed, higher frequencies of severe disease (39.2% vs. 21.2%, p = .005), complications and recurrence (21.6% vs. 10.9%, p = .037 and 14.9% vs. 5.8%, p = .029; respectively) were observed in patients where CDT was detected. TcdB and CDT act as prognostic markers of the appearance of serious disease, complications or recurrence in cases of CDI. Simultaneous detection of both markers, TcdB and CDT, had a greater impact on the prognosis than when they were detected separately.
Assuntos
ADP Ribose Transferases/análise , Proteínas de Bactérias/análise , Toxinas Bacterianas/análise , Clostridioides difficile/metabolismo , Infecções por Clostridium/microbiologia , ADP Ribose Transferases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Proteínas de Bactérias/metabolismo , Toxinas Bacterianas/metabolismo , Clostridioides difficile/genética , Infecções por Clostridium/complicações , Infecções por Clostridium/diagnóstico , Fezes/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto JovemRESUMO
Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.
Assuntos
Gerenciamento Clínico , Infecções Respiratórias/tratamento farmacológico , Adulto , Algoritmos , Analgésicos/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bronquiectasia/complicações , Bronquite/diagnóstico , Bronquite/tratamento farmacológico , Criança , Epiglotite/diagnóstico , Epiglotite/tratamento farmacológico , Humanos , Laringite/diagnóstico , Laringite/tratamento farmacológico , Otite Externa/diagnóstico , Otite Externa/tratamento farmacológico , Otite Média/diagnóstico , Otite Média/tratamento farmacológico , Faringite/diagnóstico , Faringite/tratamento farmacológico , Faringite/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Tonsilite/diagnóstico , Tonsilite/tratamento farmacológico , Tonsilite/prevenção & controleRESUMO
Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.