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.

Clostridium difficile, ¿están todos los que son? / Clostridium difficile, are all our patients diagnosed?

Antecedentes: Una ajustada correlación entre el diagnóstico clínico y el microbiológico de la infección por Clostridium difficile (ICD) es fundamental para identificar la gravedad de este problema sanitario y realizar un correcto abordaje a nivel individual y poblacional. Objetivos: a) Evaluar si existía una correlación entre los diagnósticos microbiológico y clínico en la ICD; y b) conocer si una posible discordancia entre los diagnósticos clínico y microbiológico se asociaba a características clínicas de los pacientes, actitud terapéutica y evolución diferentes. Pacientes y métodos: Estudio retrospectivo (datos clínicos y epidemiológicos) de los pacientes con diagnóstico microbiológico de ICD en 2013 en el Hospital Clínico San Carlos de Madrid, según se hubiese incluido este diagnóstico en el informe de alta. Resultados: De las 33.317 altas de 2013 se detectaron microbiológicamente 204 casos de ICD. De estos, solo el 51,5% incluían este diagnóstico en su informe de alta. Los pacientes que incluían este diagnóstico al alta fueron pacientes más añosos y con mayor dependencia funcional (p < 0,05). El grupo que tenía diagnóstico clínico recibió tratamiento para la ICD más frecuentemente (p < 0,001). Una menor tasa de tratamiento de la ICD se asoció a mayor mortalidad (p = 0,032). Conclusiones: Casi la mitad de los pacientes con diagnóstico microbiológico de ICD no incluyen este diagnóstico en su informe de alta. Los pacientes sin diagnóstico clínico son más jóvenes, con menor deterioro funcional y reciben menos frecuentemente el tratamiento correspondiente. No recibir la antibioterapia específica para el tratamiento de la ICD se asocia a una mayor mortalidad (AU)

Background: A close correlation between clinical and microbiological diagnosis in Clostridium difficile infection (CDI) is very important to identify how severe is this health problem, and to approach its correct management of it, individually and as a population problem. Objetives: a) To evaluate if there is an adequate correlation between the microbiological and clinical diagnosis in CDI patients; b) to determine if the discordance between the microbiological and clinical diagnosis could be associated with different clinical patient characteristics, therapeutic attitudes, and outcomes. Patients and methods: A retrospective study was conducted, using clinical and epidemiologic data, on inpatients with a microbiological diagnosis of CDI in 2013 in the Hospital Clínico San Carlos in Madrid (Spain), depending on whether their clinical ICD diagnosis was included. Results: From a total of 33,317 discharged patients, 204 patients had a CDI diagnosis. Only 51.5% patients had this diagnosis stated in their discharge report. Patients on whom the clinical diagnosis was included, were older, had higher level of dependence (P < .05), and received treatment for CDI more frequently (P < .001) than patients who did not have the clinical diagnosis included. A lower treatment rate was associated with a higher mortality (P = .032). Conclusions: Nearly half of patients with a microbiological diagnosis of CDI did not have the clinical diagnosis included in their clinical report. Patients without the clinical diagnosis were younger, had less disability, and received specific antibiotics for CDI less frequently. Not receiving specific antibiotics for CDI was associated with higher mortality (AU)

[Clostridium difficile, are all our patients diagnosed?]. / Clostridium difficile, ¿están todos los que son?

BACKGROUND: A close correlation between clinical and microbiological diagnosis in Clostridium difficile infection (CDI) is very important to identify how severe is this health problem, and to approach its correct management of it, individually and as a population problem. OBJETIVES: a) To evaluate if there is an adequate correlation between the microbiological and clinical diagnosis in CDI patients; b) to determine if the discordance between the microbiological and clinical diagnosis could be associated with different clinical patient characteristics, therapeutic attitudes, and outcomes. PATIENTS AND METHODS: A retrospective study was conducted, using clinical and epidemiologic data, on inpatients with a microbiological diagnosis of CDI in 2013 in the Hospital Clínico San Carlos in Madrid (Spain), depending on whether their clinical ICD diagnosis was included. RESULTS: From a total of 33,317 discharged patients, 204 patients had a CDI diagnosis. Only 51.5% patients had this diagnosis stated in their discharge report. Patients on whom the clinical diagnosis was included, were older, had higher level of dependence (P<.05), and received treatment for CDI more frequently (P<.001) than patients who did not have the clinical diagnosis included. A lower treatment rate was associated with a higher mortality (P=.032) CONCLUSIONS: Nearly half of patients with a microbiological diagnosis of CDI did not have the clinical diagnosis included in their clinical report. Patients without the clinical diagnosis were younger, had less disability, and received specific antibiotics for CDI less frequently. Not receiving specific antibiotics for CDI was associated with higher mortality.

La malaria en el mundo. ¿Qué debe saber un pediatra? (II): diagnóstico, prevención y tratamiento / Malaria in the world. What needs to know a paediatrician? (II): diagnosis, prevention and treatment

La malaria es una enfermedad que afecta a los países pobres tropicales y subtropicalespero que se observa, en su forma importada, con una frecuencia cada vez mayor en loshospitales españoles. La situación de la malaria en el mundo dista de estar controlada yaque cada año se producen entre 350 y 500 millones de casos y mueren más de un millónde niños por esta enfermedad, fundamentalmente en el África subsahariana. El adecuadoconocimiento de la malaria requiere una aproximación a la enfermedad desde un punto devista multidisciplinar, integrando conocimientos biológicos, clínicos, epidemiológicos ysocioeconómicos. El pediatra español debe estar preparado para afrontar una enfermedada la que no está habituado, y cuya potencial gravedad no permite retrasos en el diagnóstico.En este artículo se repasan ciertos conceptos básicos sobre la enfermedad, con el objetivode dar una visión global que permita al pediatra, tanto a nivel ambulatorio como hospitalario,tener un correcto conocimiento sobre el diagnóstico, el tratamiento y laprevención de la enfermedad.El texto se ha articulado en dos partes. En la primera se han descrito los aspectos epidemiológicos,biológicos y clínicos; esta segunda parte se dedica a la descripción del diagnóstico,la prevención y el tratamiento

Malaria affects poor tropical and subtropical countries, but it is observed as an importedillness, with increasing frequency in Spanish hospitals. The situation of malaria in the worldis far from being controlled, with 350 to 500 million clinical cases per year and more thanone million child deaths, predominantly in Africa. The adequate understanding of malaria requiresa multidisciplinary approach, integrating biological, clinical, epidemiological and socio-economic knowledge. The Spanish paediatrician must be prepared to deal with an unfamiliar disease, and whose potential severity allows no diagnostic delay. In this article we describesome basic concepts about the illness, with the objective of giving a global view whichallows the paediatrician, whether at the hospital or primary health care level, to correctly understandthe diagnosis, management and prevention of the illness. The text has been dividedinto two sections. In the first section, the epidemiological, biological and clinical aspects ofmalaria were exposed. This second section covers the diagnosis, prevention and treatment ofmalaria

La malaria en el mundo. ¿Qué debe saber un pediatra? (I): perspectiva histórica, etiología, epidemiología, patogenia y manifestaciones clínicas / No disponible

La malaria es una enfermedad que afecta a los países pobres tropicales y subtropicales pero que se observa, en su forma importada, con una frecuencia cada vez mayor en los hospitales españoles. La situación de la malaria en el mundo dista de estar controlada ya que cada año se producen entre 350 y 500 millones de casos y mueren más de un millón de niños por esta enfermedad, fundamentalmente en África subsahariana. El adecuado conocimiento de la malaria requiere una aproximación a la enfermedad desde un punto de vista multidisciplinar, integrando conocimientos biológicos, clínicos, epidemiológicos y socioeconómicos. El pediatra español debe estar preparado para afrontar una enfermedad a la queno está habituado y cuya potencial gravedad no permite retrasos en el diagnóstico. En este artículo se repasan ciertos conceptos básicos sobre la enfermedad, con el objetivo de dar una visión global que permita al pediatra, tanto a nivel ambulatorio como hospitalario, tener un correcto conocimiento sobre el diagnóstico, el tratamiento y la prevención de la enfermedad. El texto se ha articulado en dos partes. En esta primera parte se exponen los aspectos epidemiológicos, biológicos y clínicos, y la segunda se dedica a la exposición del diagnóstico, la prevención y el tratamiento

Malaria affects poor tropical and subtropical countries, but it can be seen, as an imported illness, with increasing frequency in Spanish hospitals. The situation of malaria in the world is far from being controlled, with 350 to 500 million clinical cases per year and morethan one million children deaths, predominantly in Africa. The adequate understanding of malaria requires a multidisciplinary approach, integrating biological, clinical, epidemiological and socioeconomic knowledge. The Spanish paediatrician must be prepared to deal withan unfamiliar disease whose potential severity allows no diagnostic delay. In this article we describe some basic concepts about the illness, with the objective of giving a global view which may allow the paediatrician, whether at the hospital or primary health care level, to correctly understand the diagnosis, management and prevention of the illness. The text has been divided into two sections. In this first section, the epidemiological, biological and clinical aspects are exposed. The second section covers the diagnosis, prevention and treatmentof malaria