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Avaliação dos fatores de risco em doentes com infeção por Clostridium difficile e o seu seguimento durante o internamento
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Introdução: Tem-se verificado uma incidência crescente da Doença Associada a Clostridium difficile (DACD), com elevada morbilidade e mortalidade. Tipicamente trata-se de uma infeção nosocomial, cujo principal fator de risco é a antibioterapia. O objetivo primário deste trabalho centrou-se no reconhecimento dos fatores de risco para a infeção por C.difficile, de forma a otimizar a sua terapêutica e prevenção.
Métodos: Foi realizado um estudo retrospetivo dos doentes internados no serviço de Medicina Interna do Hospital Garcia de Orta em 2014, através da consulta do processo clínico, com identificação dos fatores de risco, tratamento e destino dos doentes.
Resultados: Foram incluídos 14 doentes, 64% do sexo feminino, com uma idade média de 80 anos. A maioria dos doentes desenvolveu DACD em ambiente hospitalar. Os fatores de risco identificados foram: idade avançada, hospitalização prolongada, presença de comorbilidades, procedimentos gastrointestinais não invasivos, uso de inibidores de bomba de protões e antibioterapia. Salienta-se a interação entre antidepressivos e a DACD. O papel das estatinas como fator de risco não foi esclarecido. O metronidazol foi usado como terapia inicial em todos os doentes. Nenhum doente apresentou critérios de gravidade clínicos ou recorrência.
Conclusão: Torna-se fundamental reconhecer os fatores de risco para DACD, explorar novas abordagens terapêuticas e reforçar o papel da prevenção.
Introduction: The incidence of Clostridium difficile-associated disease (CDAD) has increased in the last years, with significant morbidity and mortality. Typically, it’s a health care-associated infection and antibiotics are a major risk factor. The main goal of this study was to identify risk factors for CDAD, in order to optimize its treatment and prevention. Methods: a retrospective analysis of consecutive patients with CDAD admitted to the ward of Internal Medicine of Hospital Garcia de Orta during 2014 was performed, reviewing medical records for risk factors, treatment and clinical outcome. Results: 14 patients were included, 64% were female, with a mean age of 80 years. In the majority of cases, the infection was nosocomial. The risk factors identified included: advanced age, prolonged hospital stay, multiple comorbidities, nonsurgical gastrointestinal procedures, use of proton pump inhibitors and antibiotic exposure. A possible interaction between antidepressants and CDAD was identified. The use of statins as a risk factor was not established. Metronidazole was the initial therapy in all of the patients. No patients reported severe disease or recurrence. Conclusions: It is crucial to identify possible risk factors for CDAD, explore new treatment options and increase the importance of prevention.
Introduction: The incidence of Clostridium difficile-associated disease (CDAD) has increased in the last years, with significant morbidity and mortality. Typically, it’s a health care-associated infection and antibiotics are a major risk factor. The main goal of this study was to identify risk factors for CDAD, in order to optimize its treatment and prevention. Methods: a retrospective analysis of consecutive patients with CDAD admitted to the ward of Internal Medicine of Hospital Garcia de Orta during 2014 was performed, reviewing medical records for risk factors, treatment and clinical outcome. Results: 14 patients were included, 64% were female, with a mean age of 80 years. In the majority of cases, the infection was nosocomial. The risk factors identified included: advanced age, prolonged hospital stay, multiple comorbidities, nonsurgical gastrointestinal procedures, use of proton pump inhibitors and antibiotic exposure. A possible interaction between antidepressants and CDAD was identified. The use of statins as a risk factor was not established. Metronidazole was the initial therapy in all of the patients. No patients reported severe disease or recurrence. Conclusions: It is crucial to identify possible risk factors for CDAD, explore new treatment options and increase the importance of prevention.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Clostridium difficile Infecções por Clostridium