Brote nosocomial de diarrea por Clostridium difficile en un servicio de cirugía vascular

Introducción

La infección por Clostridium difficile es una causa de diarrea nosocomial poco descrita en España

Métodos

En un período de 5 meses se detectaron 35 episodios de diarrea por C. difficile diagnosticados por la detección de toxina A en heces líquidas. Se compararon 12 casos de cirugía vascular con 24 controles aleatorizados, sin diarrea. El análisis estadístico (SPSS) utilizó para las comparativas t de Student y chi cuadrado (odds ratio con intervalo de confianza del 95%)

Resultados

La incidencia global fue 3,42 frente 48 casos/1.000 ingresos en cirugía vascular. El 80% recibieron antibióticos antes del ingreso y la media durante el ingreso fue de 2,91 antibióticos/paciente. El estudio casos-controles se diseñó para estudiar los factores de riesgo del brote de vascular. El análisis reveló que los casos recibieron un mayor número de antibióticos antes (p = 0,0031) y durante el ingreso (p = 0,000), siendo la clindamicina sola (p = 0,001) o asociada a aztreonam (p = 0,000) los más utilizados

Conclusiones

La diarrea por C. difficile es frecuente en nuestro medio, su diagnóstico exige un elevado índice de sospecha. Se publica un brote atribuido al uso de clindamicina y/o aztreonam. Las medidas de control y la restricción en el uso de antibióticos fueron efectivos

Introduction

Nosocomial diarrhea outbreak due to Clostridium difficile in a vascular surgery department. Clostridium difficile is considered the most common cause of nosocomial-acquired diarrhea. In Spain this condition is rarely reported

Methods

Over a five-month period, 35 episodes of C. difficile diarrhea were diagnosed by toxin A detection in stool samples. Case-control studies were designed to assess risk factors for the outbreak. Twelve cases from the vascular surgery department were compared with 24 randomized controls, patients admitted to the same ward during this period, but without diarrhea. Statistical comparisons (SPSS software) were performed with the Student’s t and X2 tests (OR with 95% CI)

Results

Overall incidence was 3.42 episodes: 48 episodes/1000 admissions to vascular surgery. Among the total, 80% had received antibiotics before admission and the mean number of antibiotics administered was 2.91 per patient. Comparative analyses disclosed that the cases had received a larger number of antibiotics during hospitalization (p = 0.000) and in the two months before admission (p = 0.031) than the controls. Clindamycin administered alone (p = 0.001) or associated with aztreonam (p = 0.000) were the most frequently used antibiotic treatments

Conclusions

C. difficile diarrhea is common in our setting. Diagnosis requires a high index of suspicion. We attribute the nosocomial outbreak in our vascular surgery department to broad-spectrum antibiotic use (clindamycin and aztreonam). Surveillance, together with restriction of antibiotic use was effective for control