Brote de diarrea nosocomial por Clostridium difficile enun servicio de medicina interna

Background: Clostridium difficile (DCD) is the main etiologic agent of nosocomial diarrhea of infectious origin. Most of the cases of DCD have been detected in a hospital environment.
Patients, material and methods: From October to November 1996 five cases of nosocomial diarrhea were detected with the presence of the toxin A of Clostridium difficile being observed in the stools. These patients were compared with a group of 19 patients without diarrhea (controls) who were admitted to the same ward during the same period as the patients with DCD.
Results: The hospital stay of the cases was greater (25±8 days) than that of the controls (14 ± 10 days; p<0.05). One hundred percent of the cases received antibiotics during admission (2 ± 1.2 antibiotics per patient), versus 68% of the controls (1.1 ± 0.9 antibiotics per patient, p > 0.05). The length of antibiotic treatment prior to the onset of the symptoms was 8 ± 3 days (range 7-11 days). The type of antibiotic administered was similar in both groups. More of the cases with DCD (60%) had vesicle catherization than the controls (11%, p< 0.05). All the patients with DCD presented abdominal pain and several liquid stools per day without blood or pus (3.2±0.45 stools per patient) and 2 (40%) fever. The mean length of diarrhea was 5.6 ± 3.6 days. The serum albumin concentration on the first day of admission was significantly lower in the cases of DCD (2.9 ± 0.4 mg/dl) than in the controls (3.3 ± 3.4 mg/dl, p < 0.05). All the cases received antibiotic treatment for Clostridium difficile (oral metronidazol or vancomycin) with good clinical evolution.
Conclusions.: The patients with DCD had more often had vesicle catherization and presented a lower serum albumin concentration than the controls