{"id":73393,"date":"2023-10-05T11:11:15","date_gmt":"2023-10-05T09:11:15","guid":{"rendered":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/?p=73393"},"modified":"2024-02-23T09:08:23","modified_gmt":"2024-02-23T08:08:23","slug":"brote-por-clostridium-difficile-en-un-hospital-general-del-sector-salud-en-mexico","status":"publish","type":"post","link":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/brote-por-clostridium-difficile-en-un-hospital-general-del-sector-salud-en-mexico\/","title":{"rendered":"Brote por clostridium difficile en un hospital general del sector salud en M\u00e9xico"},"content":{"rendered":"

Brote por clostridium difficile en un hospital general del sector salud en M\u00e9xico<\/strong><\/p>\n

Autor principal: Marco Antonio Paredes Monta\u00f1o<\/p>\n

Vol. XVIII; n\u00ba 19; 996<\/p>\n

Outbreak by clostridium difficile in a general hospital of the health sector hospital in Mexico<\/strong><\/p>\n

Fecha de recepci\u00f3n: 04\/09\/2023<\/p>\n

Fecha de aceptaci\u00f3n: 02\/10\/2023<\/p>\n

Incluido en Revista Electr\u00f3nica de PortalesMedicos.com Volumen XVIII. N\u00famero 19 Primera quincena de Octubre de 2023 \u2013 P\u00e1gina inicial: Vol. XVIII; n\u00ba 19; 996<\/p>\n

Autores: <\/strong>Marco Antonio Paredes Monta\u00f1o1<\/sup>, Carlos Navarrete V\u00e1zquez2<\/sup><\/p>\n

Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Toluca M\u00e9xico.1-2<\/sup><\/p>\n

Declaraci\u00f3n de buenas pr\u00e1cticas<\/strong><\/p>\n

Los autores de este manuscrito declaran que:<\/p>\n

Todos ellos han participado en su elaboraci\u00f3n y no tienen conflictos de intereses<\/p>\n

La investigaci\u00f3n se ha realizado siguiendo las Pautas \u00e9ticas internacionales para la investigaci\u00f3n relacionada con la salud con seres humanos elaboradas por el Consejo de Organizaciones Internacionales de las Ciencias M\u00e9dicas (CIOMS) en colaboraci\u00f3n con la Organizaci\u00f3n Mundial de la Salud (OMS).<\/p>\n

El manuscrito es original y no contiene plagio.<\/p>\n

El manuscrito no ha sido publicado en ning\u00fan medio y no est\u00e1 en proceso de revisi\u00f3n en otra revista.<\/p>\n

Han obtenido los permisos necesarios para las im\u00e1genes y gr\u00e1ficos utilizados.<\/p>\n

Han preservado las identidades de los pacientes.<\/p>\n

RESUMEN<\/strong><\/p>\n

Introducci\u00f3n: <\/strong>El Clostridium difficile es un anaerobio grampositivo oportunista cuya patogenicidad est\u00e1 asociada con la producci\u00f3n de dos exotoxinas: la toxina A (enterotoxina) y la toxina B (citotoxina). El organismo a menudo est\u00e1 presente en las manos del personal del hospital que atiende a dichos pacientes. Los factores de riesgo son: hospitalizaci\u00f3n, edad avanzada, inmunodepresi\u00f3n, exposici\u00f3n a antibi\u00f3ticos y el uso de inhibidores de la bomba de protones.<\/p>\n

Presentaci\u00f3n de Caso Cl\u00ednico: <\/strong>El 3 de marzo del 2021 se detect\u00f3 el primer caso en el \u00e1rea de COVID19, el paciente present\u00f3 fiebre, dolor abdominal, acompa\u00f1ado de distensi\u00f3n, diarrea y leucositosis, el paciente contaba con factores de riesgo. En total se presentaron 18 casos del 3 de marzo al 9 de abril del 2021, 8 casos confirmados por laboratorio, los 10 restantes positivos por asociaci\u00f3n epidemiol\u00f3gica, fallecieron 9 pacientes y 9 fueron dados de alta. La asociaci\u00f3n entre los casos era el personal de salud, debido a que usaban guantes en el \u00e1rea covid, lo que favoreci\u00f3 a la transmisi\u00f3n cruzada.<\/p>\n

Discusi\u00f3n y conclusi\u00f3n: <\/strong>La falta de aplicaci\u00f3n de los procedimientos por el personal de salud para prevenir infecciones cruzadas contin\u00faa siendo un problema para los hospitales, a pesar de recibir capacitaciones de diversos t\u00f3picos, existe personal que hace caso omiso a las indicaciones, las cuales exponen a los pacientes a complicaciones que ponen en peligro la vida y tambi\u00e9n incrementan la permanencia de los pacientes y los costos de atenci\u00f3n. El tratamiento para el Clostridium difficile puede ser con metronidazol o vancomicina o fidaxomicina, la rifampicina o la adici\u00f3n por v\u00eda oral de la levadura Saccharomyces boulardii al tratamiento con vancomicina o metronidazol previene la diarrea subsiguiente en pacientes con enfermedad recurrente. La limpieza y desinfecci\u00f3n de las \u00e1reas, mobiliario, equipo, etc. es esencial para el control de brotes hospitalarios.<\/p>\n

Palabras clave: <\/strong>Clostridium Difficile, hospitales, Infecci\u00f3n cruzada, bacterias, riesgo.<\/p>\n

SUMMARY<\/strong><\/p>\n

Introduction: <\/strong>Clostridium difficile is an opportunistic gram-positive anaerobe whose pathogenicity is associated with the production of two exotoxins: toxin A (enterotoxin) and toxin B (cytotoxin). The organism is often present on the hands of hospital personnel caring for such patients. Risk factors are: hospitalization, advanced age, immunosuppression, exposure to antibiotics, and the use of proton pump inhibitors.<\/p>\n

Clinical Case: <\/strong>On March 3, 2021, the first case of COVID19 was detected in the area, the patient presented fever, abdominal pain, accompanied by distension, diarrhea and leukocytosis, the patient had risk factors. In total, there were 18 cases from March 3 to April 9, 2021, 8 laboratory-confirmed cases, the remaining 10 positive due to epidemiological association, 9 patients died and 9 were discharged. The association between the cases was health personnel, because they used gloves in the covid area, which favored cross-transmission.<\/p>\n

Discussion and conclusion: <\/strong>The lack of application of procedures by health personnel to prevent cross infections continues to be a problem for hospitals, despite receiving training on various topics, there are personnel who ignore the indications, which expose patients to complications that are life-threatening and also increase patient length of stay and costs of care. Treatment for Clostridium difficile can be with metronidazole or vancomycin or fidaxomicin, rifampin or the oral addition of the yeast Saccharomyces boulardii to vancomycin or metronidazole treatment prevents subsequent diarrhea in patients with recurrent disease. Cleaning and disinfection of areas, furniture, equipment, etc. it is essential for the control of hospital outbreaks.<\/p>\n

Keywords: <\/strong>Clostridium Difficile, hospitals, cross infection, bacteria, risk.<\/p>\n

Introduction<\/strong><\/p>\n

Clostridium difficile made its first appearance in the literature when Hall and O’Toole (1935) described Bacillus dificilis as part of the bacterial flora of meconium and feces of infants.1-2<\/sup><\/p>\n

Clostridium difficile is an opportunistic gram-positive anaerobe whose pathogenicity is associated with the production of two exotoxins: toxin A (enterotoxin) and toxin B (cytotoxin).3<\/sup><\/p>\n

Infection of the colon with the gram-positive bacterium Clostridium difficile is life-threatening, especially in the elderly and in patients who have gut microbiota dysbiosis after exposure to antimicrobial drugs. C. difficile is the leading cause of healthcare-associated infectious diarrhea, its life cycle is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites.4<\/sup><\/p>\n

Contagion and transmission in hospitalized patients of C. difficile is well documented5, 6, 7 8<\/sup>, the organism is often present on the hands of hospital personnel caring for such patients.9<\/sup><\/p>\n

The fundamental risk factors: hospitalization, institutionalization in residences, advanced age, immunosuppression, history of gastrointestinal surgery, exposure to antibiotics and the use of proton pump inhibitors (PPIs) have also been described as a possible risk factor.10-11-12-13-14<\/sup><\/p>\n

In the United States, C. difficile diarrhea was associated with an increase in estimated total hospital costs of $3,669 and an increase in length of hospital stay of 3.6 days. The crude mortality rate of patients with C. difficile diarrhea was higher than that of patients without C. difficile diarrhea.15<\/sup><\/p>\n

Clinical case<\/strong><\/p>\n

On March 3, 2021, a case of gastroenteritis was detected in the isolated area for COVID19 patients, the epidemiology service was consulted, due to fever, abdominal pain, accompanied by distension, diarrhea and leukocytosis, with a diagnosis of probable gastroenteritis. by Clostridium difficile, since the patient had risk factors due to the prolonged use of antibiotics and omeprazole, these factors favor the loss of the normal microbiota of the gastrointestinal tract, coupled with the fact that omeprazole favors conditions at the level of the gastric mucosa by neutralizing the acidic pH of the stomach, which in turn serves as a protective mechanism against the presence of intestinal pathogens.<\/p>\n

Laboratory studies were requested for the detection of toxins A and B for C. difficile by multiplex PCR, the report was positive for the detection of toxins A\/B of clostridioides (Clostridium difficile), starting treatment with vancomycin. Based on NOM-017-SSA-2012, an outbreak was considered since subsection 3.1.4, where an Outbreak is defined as \u201cthe occurrence of two or more cases epidemiologically associated with each other. The existence of a single case under special surveillance in an area where the disease did not exist is also considered an outbreak.<\/p>\n

On March 9, a second case was detected for which a laboratory study could not be carried out due to lack of supplies, considering it positive due to epidemiological association based on NOM-017-SSA-2012. On March 12, 3 more cases were presented , of these three cases for the same reason as the previous one, only one of them underwent the specific study, the result being positive for the detection of clostridoid A\/B toxins, the two remaining cases were positive due to epidemiological association. In the period of March 15, two more cases were presented, one underwent laboratory studies, being positive for the detection of clostridoid toxins A\/B, the second case of the day was positive due to epidemiological association.<\/p>\n

At this time, it was found that the association between these cases was health personnel, because they used gloves in the covid area and did not wash their hands, which favored cross-transmission generated by health personnel. It is important to reiterate that this outbreak was detected in the covid area, where medical and paramedical personnel use maximum barrier protection equipment characterized by: tivek type suit, googles, KN \u200b\u200b95, two pairs of gloves and boots<\/p>\n

From March 17 to April 9, 11 more cases were presented, of which 7 cases underwent laboratory studies, being positive and the remaining 4 cases were found to be positive due to epidemiological association (Table 1 and 2). All patients were I treat them with vancomycin, their evolution for the condition being satisfactory, however some died from the complications of COVID19.<\/p>\n

Discussion<\/strong><\/p>\n

Cleaning and disinfection is the cornerstone for the control of hospital outbreaks, some forms of life, such as spores, can survive for more than 6 months, so monitoring and active search for probable cases of C. Difficile diarrhea continue. however, as of March 21, 2023, no positive cases have been found by laboratory or by epidemiological association.<\/p>\n

In most patients, C. difficile colitis resolves after treatment with metronidazole or vancomycin; however, a significant minority develop progressive systemic symptoms despite appropriate and timely medical therapy.16-17-18-19-20-21<\/sup><\/p>\n

However, fidaxomicin is significantly more effective than vancomycin in achieving clinical cure in the presence of concomitant antibiotic (AC) therapy and in preventing recurrence regardless of the use of AC.22<\/sup><\/p>\n

Combination therapy with vancomycin plus rifampicin or the oral addition of the yeast Saccharomyces boulardii to vancomycin or metronidazole therapy has been shown to prevent subsequent diarrhea in patients with recurrent disease.23<\/sup><\/p>\n

Conclusions<\/strong><\/p>\n

The lack of application or omission of procedures by health personnel to prevent cross infections continues to be a problem for hospital units, despite receiving training on various topics, there are health personnel who ignore the recommendations and indications, which expose patients to life-threatening complications and also increase patient length of stay and costs of care.<\/p>\n

Anexo<\/strong><\/a><\/p>\n

References<\/strong><\/p>\n

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