Clostridium difficile infection in patients with chronic kidney disease in Mexico
| Autor: | Guillermo Garcia Garcia, Rodrigo Escobedo-Sanchez, Alfonso Fernandez-Ramirez, Sara A. Aguirre-Diaz, Elvira Garza-González, Francisco Cardenas-Lara, Margarita Ibarra-Hernandez, Héctor R. Pérez-Gómez, Eduardo Rodríguez-Noriega, Rayo Morfin-Otero, Gerardo Leon Garnica, Adrián Martínez-Meléndez, Esteban Gonzalez-Diaz, S. Esparza-Ahumada |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Abdominal pain medicine.medical_specialty genetic structures business.industry Mortality rate 030106 microbiology General Medicine Odds ratio Abdominal distension Clostridium difficile medicine.disease Confidence interval 03 medical and health sciences Diarrhea 0302 clinical medicine 030228 respiratory system Nephrology Internal medicine medicine medicine.symptom business Kidney disease |
| Zdroj: | Clinical Nephrology. 90:350-356 |
| ISSN: | 0301-0430 |
| DOI: | 10.5414/cn109387 |
| Popis: | Background Clostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea worldwide. Patients with chronic kidney disease (CKD) are especially vulnerable, as they are exposed to CDI risk factors including frequent antibiotics. Materials and methods In order to identify the risk factors for CDI in CKD patients, a 33-month long case-control study was carried out at a tertiary-care hospital in Mexico. CDI was confirmed at the genetic level, and univariate and multivariate analyses were performed to identify the association between risk factors, biomarkers, and outcome options (survival, relapse, death). Results Among the 1,198 patients with healthcare-associated diarrhea, 354 (29.5%) were CDI cases. 105 (29.6%) CDI cases and 192 (22.7%) controls had CKD. 84 (80%) CKD+CDI cases had a favorable outcome, 10 (9.5%) relapsed, and the 3-month mortality rate included 11 (10.4%) patients. Compared with controls, CDI cases had more previous hospitalizations (63.8 vs. 46.9%, p = 0.005), abdominal distension (46.7 vs. 36.5%, p = 0.056), abdominal pain (60.0 vs. 41.1%, p = 0.002), and polymorphonuclear leukocyte in stools (71.4 vs. 40.5%, p = 0.001) as well as poorer outcomes at 3 months. The patients in the 027-strain group were older, and most of the patients had CKD stage 5 (88.5% vs. 71.1%, p = 0.007), while CKD stage-4 patients were more frequently infected with non-027 strains. In the multivariate analysis of risk factors for CDI, only previous antibiotic exposure (odds ratio = 2.01, 95% confidence interval: 1.05 - 3.84; p = 0.034) was independently associated with CDI in patients with CKD stage 5. Conclusion Mexican patients with CKD are at risk for CDI. This susceptible group should be protected by promoting appropriate guidelines. . |
| Databáze: | OpenAIRE |
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