Clinical and endoscopic features in patients with hospital-acquired diarrhea associated with Clostridium difficile infection. / Características clínicas y endoscópicas en diarrea hospitalaria asociada a infección por Clostridium difficile.

INTRODUCTION AND AIMS: Clostridium difficile infection is the main cause of hospital-acquired diarrhea, and the clinical and endoscopic findings in those patients have been studied very little in Mexico. The aim of the present study was to describe those findings. MATERIALS AND METHODS: A prospective cohort study was conducted that included patients with hospital-acquired diarrhea associated with Clostridium difficile diagnosed through polymerase chain reaction. The hypervirulent NAP027 strain was also determined. The clinical and endoscopic findings in the study patients, as well as the variables associated with severity, were analyzed. RESULTS: Of the 127 patients with hospital-acquired diarrhea, 97 were excluded from the study due to lack of colonoscopy. The remaining 39 study patients had a mean age of 48 years, and their most common signs/symptoms were abdominal pain (49%), mucus in stools (41%), and blood in stools (10%). The most common alterations in the laboratory results were leukocytosis in 49%, fecal leukocytes (61%), and hypoalbuminemia (67%). The main risk factor was antibiotic use in 62%, and ceftriaxone was the most widely used. The hypervirulent strain was present in 54% of the cases. Endoscopic abnormalities were found in 87% of the patients. Thirty-eight percent presented with pseudomembranous colitis, with lesions in the left colon in 53%, and in the right colon in 13%. No association was found between proton-pump inhibitor use and Clostridium difficile-associated diarrhea. There was a significant association between hypoalbuminemia (< 3.3g/dL) and a greater risk for severe colitis, with a RR of 8.2 (p=0.008). CONCLUSIONS: Pseudomembranous colitis lesions associated with the hypervirulent Clostridium difficile strain were predominant in the left colon. Hypoalbuminemia was a significant severity predictor.

Acute toxicity after hypofractionated conformal radiotherapy for localized prostate cancer: nonrandomized contemporary comparison with standard fractionation.

PURPOSE: To prospectively study acute rectal and urinary reactions from three-dimensional conformal external beam radiotherapy for localized prostate cancer comparing two hypofractionation regimens with standard fractionation (standard). The hypofractionation regimens were designed to avoid more late reactions in the hypofractionation groups than in the standard group, with the advantage of one-half as many treatment sessions. PATIENTS AND MATERIALS: A total of 56 nonrandomized patients chose hypofractionation delivered at 3 (n = 22) or 3.15 (n = 34) Gy/fraction, 4 d/wk, to a total dose of 60 or 63 Gy within 5 weeks. A total of 74 patients were contemporarily treated with standard fractionation at 2 Gy/fraction, 5 d/wk, to a total dose of 76 to 80 Gy. RESULTS: The differences within patients without complications were not statistically significant in the three groups. However, for acute complications of Grade 2 or worse, the Hypo3.15 group had significantly greater (p = 0.001) complication rates (50%) compared with the standard group (17%). The incidence of patients without acute rectal complications was significantly lower for the Hypo3.15 group compared with the Hypo3 and standard groups. The incidence of rectal Grade 2 or greater complications was correspondingly significantly greater for the Hypo3.15 group than for the Hypo3 and standard groups (p < 0.001). The incidence of patients with urinary complications was not significantly different among the three groups. CONCLUSIONS: Acute rectal reactions were more frequent and intense in the Hypo3.15 group than in the Hypo3 and standard groups. In our study, 60 Gy at 3 Gy/fraction within 5 weeks resulted in acute toxicity similar to that after standard fractionation.