Resumen

Introduction: Clostridium difficile-associated disease (CDAD) has been clearly associated with the use of broadspectrum antibiotics worldwide. However, information about CDAD is scarce in Mexico and Latin America. Material and methods: We studied clinical characteristics associated factors and outcomes of all cases of CDAD diagnosed by toxin A fecal detection in a tertiary care hospital in Mexico City from 2003 to 2007. Cases were paired with controls by date of hospital discharge. Results: A total of 3170 tests were performed; we evaluated 113 cases and 226 controls, with an incidence of 5.04 cases x 1000 hospital discharges during the study period. There was no difference in gender or primary diagnosis. After multivariate analysis, we found as significant risks the following: use of H2 blockers (OR 21.73, 95% CI 7.14-66.67, p < 0.001), age < 65 y (OR 10.21, IC95% 2.74-38.00, p < 0.001), prior hospitalization within 12 weeks of diagnosis (OM 4.39, IC95% 1.81- 40.64, p < 0.001), prior use of cephalosporins (OR 3.41, CI 95% 1.56-7.46, p = 0.002), and fluoroquinolones (OR 3.11, IC95% 1.12-8.62, p = 0.029), stay at the intensive care unit (ICU) (OR 2.76, IC95% 1.38-5.49, p = 0.004); and, extended hospital stay (OR 1.10, IC95% 1.05 . 1.16, p < 0.001) or antimicrobial use before diagnosis (OR 1.05, IC95% 1.01-1.09, p = 0.010). We described an outbreak of 12 cases occurred in August of 2005 (29.5 cases per 1000 discharges). We also observed a higher seasonal incidence of disease during the summer in the study period. Conclusion: The use of H2 blockers, age < 65 years, prior hospitalization or earlier use of cephalosporins or fluoroquinolones, as well as stay at the ICU were independent risk factors for CDAD.

Palabras clave: Clostridium difficile colitis due to antibiotics toxin A.

2010-06-15   |   841 visitas   |   Evalua este artículo 0 valoraciones

Vol. 61 Núm.5. Septiembre-Octubre 2009 Pags. 371-377 Rev Invest Clin 2009; 61(5-ENGLISH)