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Regime de pulsos de vancomicina na terapêutica da recorrência da infeção por Clostridioides Difficile no CHLN entre 2017 e 2018
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Resumo(s)
A prevalência de infeção por Clostridioides difficile tem aumentado desde o início do século XXI, tornando-se um problema de saúde publica e representando a principal causa de diarreia associada aos cuidados de saúde. Uma taxa significativa dos casos apresenta recorrência a curto prazo, com necessidade de uso de terapêuticas com menor suporte em dados científicos. O uso de regimes alternativos de vancomicina tem o objetivo de realizar uma pressão sobre os esporos de C. difficile enquanto existe recuperação da flora microbiota, no entanto são poucos os estudos que abordam este novo regime terapêutico.
Métodos: Análise retrospetiva e transversal com colheita de todos os casos de utilização de pulsos de vancomicina entre 2017 e 2018.
Resultados: Durante o período de janeiro de 2017 a dezembro de 2018 foram identificados 252 testes de diagnóstico compatíveis com infeção por Clostridioides difficile no Centro Hospitalar Universitário Lisboa Norte, que mostraram taxas de incidência de 18,2 casos por cada 10.000 internamentos, com uma taxa de recorrência de 8,6%. Foram encontrados 14 casos de uso de regime de pulsos de vancomicina, sendo analisados 13 destes. A população apresentava vários fatores de risco, como idade avançada, antibioterapia anterior ao episodio de infeção por C. difficile, comorbidades múltiplas, uso de inibidores da bomba de protões e internamentos prévios. Verificou-se uma taxa de recorrência de 23%, que correspondeu a uma primeira recorrência e duas terceiras recorrências. A taxa de mortalidade associada à infeção por C. difficile foi de 8%.
Conclusões: Verificaram-se taxas de incidência e recorrência inferiores à encontrada noutro estudo realizado entre 2009 e 2015 no Centro Hospitalar e Universitário de Coimbra. A taxa de recorrência encontrada com regime de pulsos de vancomicina é inferior à da terapêutica standard com vancomicina, mas possui limitações técnicas. São necessários mais estudos para avaliar a eficácia de pulsos de vancomicina na terapêutica da recorrência de C. difficile.
The infection by Clostridioides difficile has been showing an increase in prevalence since the beginning of the century, becoming a major public health problem and the leading cause of healthcare associated diarrhea. A significant rate of the cases develops a short-term recurrence, requiring the use of therapies that present less scientific evidence. The use of alternative therapies using vancomycin has the objective of exerting a negative pressure on the C. difficile spores while there is a recovery of the microbiota flora, however there are few studies addressing this new therapeutic regime. Methods: Retrospective and transversal analysis of all cases of vancomycin pulses between 2017 and 2018. Results: From January 2017 to December 2018, 252 diagnostic tests compatible with Clostridioides difficile infection were identified at Centro Hospitalar Universitário Lisboa Norte, which showed average incidence rates of 18.2 cases per 10,000 admissions, and a rate of recurrence rate of 8.6%. We found 14 cases of vancomycin pulse regimen, 13 of which were analyzed. The population had several risk factors for recurrence, such as advanced age, antibiotic therapy prior to the episode of C. difficile infection, multiple comorbidities, use of proton pump inhibitors and previous hospitalizations. It was identified a recurrence rate of 23%, which corresponded to a first recurrence and two third recurrences. The mortality rate associated with C. difficile infection was 8%. Conclusions: It was identified a lower incidence and recurrence rate than that found in another study conducted between 2009 and 2015 in the Hospital and University Center of Coimbra. The rate of recurrence found with vancomycin pulse rate is lower than that of standard vancomycin therapy, but it has technical limitations. Further studies are needed to evaluate the efficacy of vancomycin pulses in therapy of C. difficile recurrence.
The infection by Clostridioides difficile has been showing an increase in prevalence since the beginning of the century, becoming a major public health problem and the leading cause of healthcare associated diarrhea. A significant rate of the cases develops a short-term recurrence, requiring the use of therapies that present less scientific evidence. The use of alternative therapies using vancomycin has the objective of exerting a negative pressure on the C. difficile spores while there is a recovery of the microbiota flora, however there are few studies addressing this new therapeutic regime. Methods: Retrospective and transversal analysis of all cases of vancomycin pulses between 2017 and 2018. Results: From January 2017 to December 2018, 252 diagnostic tests compatible with Clostridioides difficile infection were identified at Centro Hospitalar Universitário Lisboa Norte, which showed average incidence rates of 18.2 cases per 10,000 admissions, and a rate of recurrence rate of 8.6%. We found 14 cases of vancomycin pulse regimen, 13 of which were analyzed. The population had several risk factors for recurrence, such as advanced age, antibiotic therapy prior to the episode of C. difficile infection, multiple comorbidities, use of proton pump inhibitors and previous hospitalizations. It was identified a recurrence rate of 23%, which corresponded to a first recurrence and two third recurrences. The mortality rate associated with C. difficile infection was 8%. Conclusions: It was identified a lower incidence and recurrence rate than that found in another study conducted between 2009 and 2015 in the Hospital and University Center of Coimbra. The rate of recurrence found with vancomycin pulse rate is lower than that of standard vancomycin therapy, but it has technical limitations. Further studies are needed to evaluate the efficacy of vancomycin pulses in therapy of C. difficile recurrence.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Infeção por Clostridioides Difficile Pulsos de vancomicina Recorrência da infeção Doenças transmissíveis