RESUMEN
INTRODUCTION: Clostridioides difficile is the first cause of healthcare-associated diarrhea in developed countries. In recent years the incidence of C. difficile infection (CDI) has increased worldwide. There is not much information on the topic in Mexico, and little is known about the risk factors for the infection in patients that are hospitalized in surgical services. MATERIALS AND METHODS: A case-control study was conducted that compared the epidemiologic findings and risk factors between surgical patients with PCR-confirmed CDI, surgical patients with diarrhea and a negative PCR test, and surgical patients with no diarrhea. The statistical analysis was carried out using the SPSS version 22.0 program. RESULTS: The majority of the surgical patients with CDI belonged to the areas of neurosurgery, cardiac surgery, orthopedics, and general surgery. A total of 53% of the CDI cases were associated with the hypervirulent CD NAP1/027 strain. The presence of mucus in stools (OR: 1.5, P=.001), fever (OR: 1.4, P=.011), leukocytes in stools (OR: 3.2, P<.001), hospitalization within the past 12weeks (OR: 2.0, P<.001), antibiotic use (OR: 1.3, P=.023), and ceftriaxone use (OR: 1.4, P=.01) were independent risk factors for the development of CDI. CONCLUSIONS: C. difficile-induced diarrhea in the surgical services is frequent at the Hospital Civil de Guadalajara "Fray Antonio Alcalde".
Asunto(s)
Clostridioides difficile , Infecciones por Clostridium/complicaciones , Infección Hospitalaria/complicaciones , Diarrea/microbiología , Complicaciones Posoperatorias/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica/efectos adversos , Estudios de Casos y Controles , Infecciones por Clostridium/epidemiología , Infecciones por Clostridium/etiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Diarrea/epidemiología , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Adulto JovenAsunto(s)
Farmacorresistencia Bacteriana/genética , Integrones , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/genética , beta-Lactamasas/genética , ADN Bacteriano/química , ADN Bacteriano/genética , Humanos , Masculino , México , Persona de Mediana Edad , Datos de Secuencia Molecular , Pseudomonas aeruginosa/aislamiento & purificación , Análisis de Secuencia de ADNRESUMEN
Intravenous ciprofloxacin (200 mg every 12 hours) was compared with intravenous ceftazidime (1 g every eight hours) as therapy for 62 episodes of severe infections occurring in 60 adult patients, all of whom failed previous antimicrobial therapy. The study was designed as a prospective, controlled, randomized, non-blinded trial in a tertiary university care center. A variety of infections including skin and skin structure, urinary tract, bacteremia, pneumonia, and intra-abdominal infections were treated. Clinical cure was achieved in 83.3 percent (25 of 30) of patients treated with ciprofloxacin and in 87 percent (26 of 30) of patients treated with ceftazidime (p = 0.4). Bacteriologic and overall responses were also similar in both treatment groups (p = 0.4 and 0.375, respectively). Intravenous ciprofloxacin administered twice daily is an effective treatment for severe infections caused by susceptible organisms.