Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR).

This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.

[Prescriptions of aerosol therapy. A survey of practices at the Besançon University Hospital]. / Les conditions de prescription de l'aérosolthérapie. Une enquête de pratique réalisée au CHU de Besançon.

OBJECTIVE: Prescriptions of aerosol sprays concomitantly with other drugs can raise problems of incompatibility. METHODS: Medical practices in the clinical units of the Besançon University Hospital were analyzed to assess the therapeutic indications, the most frequently prescribed drugs, possible admixtures, the nature and volume of solvents used, drug protocols and type of aerosol therapy and nebulizer used. Sixty questionnaires were sent to all the units of the University Teaching Hospital of Besançon. RESULTS: Analysis of 48 questionnaires completed by head nurses showed that 28 different drugs and 26 different admixtures were prescribed. Only 2 of the admixtures had undergone prior validation. Only 7 (26%) of the drug formulations prescribed had received marketing approval. Recognized clinical practices for the administration of aerosol therapy were not applied and the aerosol sessions were not standardized. CONCLUSION: Many prescriptions are carried out without knowledge of the chemical compatibility of co-administered medicines.

[Estimation of costs attributable to nosocomial infection: prolongation of hospitalization and calculation of alternative costs]. / Estimación del coste atribuible a la infección nosocomial: prolongación de la estancia hospitalaria y cálculo de costes alternativos.

BACKGROUND: Nosocomial infection represents a prolongation of hospital stay and an increase of costs. The aim of the study was to estimate attributable costs by means of two methods: calculation of costs resulting from an increase of hospital stay and calculation of costs attributed to services. METHODS: A matched case-control study was carried out with a cohort population. An appropriate control was found for 63 patients with surgical site infection, for 30 patients with respiratory infection and for 55 with urinary infection. The estimation of costs attributable to services includes the case-control pairs with surgical site infection and was performed of the sum of costs of diagnostic and therapeutic services rendered in the care of the surgical site infection. RESULTS: The median of postoperative stay was 21 days for cases with surgical site infection vs 10 days for controls (p < 0.001); the median length of stay was 21.5 days for cases with respiratory infection vs 11.5 days for controls (p < 0.01); and for urinary infection the median length of stay was 21 days for cases vs 15 days for controls (p < 0.01). The surgical site infection cost attributed to extra days was 310,310 pesetas and the surgical site infection cost attributed to service cost was 220,546 pesetas. CONCLUSIONS: Nosocomial infection produces a increase median hospital stay of 7-10 days. In absence of a precise accounting system, the prolongation of hospital stay was considered as the more objective date to estimate the costs.