Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection
Por:
Abreu y Abreu A.T., Velarde-Ruiz Velasco J.A., Zavala-Solares M.R., Remes-Troche J.M., Carmona-Sánchez R.I., Aldana-Ledesma J.M., Camacho-Ortiz A., Contreras-Omaña R., Díaz-Seoane R., Elizondo-Vázquez C.T., Garza-González E., Grajales-Figueroa G., Gómez-Escudero O., Jacobo-Karam J.S., Morales-Arámbula M., Olivares-Guzmán L.O., Sifuentes-Osornio J., Siu-Moguel A.G., Soto-Solís R., Valdovinos-García L.R., Valdovinos-Díaz M.A., Vázquez-Elizondo G., Lazo-de la Vega Jasso S.A.
Publicada:
1 ene 2019
Categoría:
Gastroenterology
Resumen:
In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. Mexico is no exception, and therefore the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, endoscopists, internists, infectious disease specialists, and microbiologists) to carry out the “Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection”, establishing useful recommendations (in relation to the adult population) for the medical community. Said recommendations are presented herein. Among them, it was recognized that CDI should be suspected in subjects with diarrhea that have a history of antibiotic and/or immunosuppressant use, but that it can also be a community-acquired infection. A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. Another recommendation was that CDI based on clinical evaluation be categorized as mild-moderate, severe, and complicated severe, given that such a classification enables better therapeutic decisions to be made. In mild-moderate CDI, oral vancomycin is the medication of choice, and metronidazole is recommended as an alternative treatment. In addition, fecal microbiota transplantation was recognized as an efficacious option in patients with recurrence or in the more severe cases of infection, and surgery should be reserved for patients with severe colitis (toxic megacolon), in whom all medical treatment has failed. © 2019 Asociación Mexicana de Gastroenterología
Filiaciones:
Hospital Ángeles de Pedregal, Ciudad de México, Mexico
Servicio de Gastroenterología, Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, Mexico
Servicio de Gastroenterología, Hospital General de México, Ciudad de México, Mexico
Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, Mexico
Unidad de Medicina Ambulatoria Christus Muguerza, San Luis Potosí, S.L.P., Mexico
Servicio de Infectología, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, Mexico
Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Pachuca, Hidalgo, Mexico
Hospital Ángeles, Villahermosa, Tabasco, Mexico
Doctors Hospital, Monterrey, Nuevo León, Mexico
Servicio de Gastroenterología, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, Mexico
Departamento de Endoscopia, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, Mexico
Clínica de Gastroenterología, Endoscopía Digestiva y Motilidad Gastrointestinal, Hospital Ángeles, Puebla, Puebla, Mexico
Hospital General 450, Secretaría de Salud, Durango, Durango, Mexico
Hospital Country 2000, Guadalajara, Jalisco, Mexico
Hospital Civil de Culiacán, Culiacán, Sinaloa, Mexico
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, Mexico
Médica Siu, Tuxtla Gutiérrez, Chiapas, Mexico
Departamento de Endoscopia, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, Mexico
Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, Mexico
Escuela Nacional de Medicina, Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
Hospital Ángeles y Hospital Lomas, San Luis Potosí, S.L.P., Mexico
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