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Inicio Medicina Clínica (English Edition) Factors associated to Clostridium difficile infection in a hospital-based home c...
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Vol. 153. Issue 8.
Pages 319-322 (October 2019)
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Vol. 153. Issue 8.
Pages 319-322 (October 2019)
Brief report
DOI: 10.1016/j.medcle.2018.08.018
Factors associated to Clostridium difficile infection in a hospital-based home care service
Factores asociados a la infección por Clostridium difficile en un servicio de hospitalización domiciliaria
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Stefanie Francesca Pinia,
Corresponding author
p.stefanie87@gmail.com

Corresponding author.
, Giusi Alessia Sgaramellaa, Juan José Parra Jordána, Ana Aguilera Zubizarretaa, Emilio Pariente Rodrigob, Pedro Sanroma Mendizabala
a Servicio de Hospitalización Domiciliaria, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Medicina de Familia, CS Camargo-Interior, Observatorio de Salud Pública de Cantabria, Camargo, Spain
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Tables (3)
Table 1. Clinical characteristics and biochemical parameters of cases and controls upon admission to the hospital-at-home scheme.
Table 2. Comorbidity in the case and control groups.
Table 3. Multiple logistic regression model.
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Abstract
Background and objective

There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system.

Patients and methods

Case–control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(−) toxin. We analyzed 82 variables.

Results

We analyzed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (p=0.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9–235.6, p=0.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8–10.3 and 3.1, 95% CI 0.8–11.3, respectively, both p=0.08).

Conclusions

Actions in the HBHCS directed toward CDI should include a reduction in the use of high-risk antibiotics – according to our results, cephalosporins – especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease.

Keywords:
Clostridium difficile
Hospital-based home care
Risk factors
Mortality
Anti-bacterial agents
Resumen
Antecedentes y objetivo

No hay datos relativos a los factores de riesgo asociados a la infección por Clostridium difficile (ICD) en los servicios de hospitalización domiciliaria (SHD) del sistema sanitario español.

Pacientes y métodos

Estudio casos-controles. Los casos fueron pacientes ingresados en un SHD entre 1 de enero de 2011 y el 31 de diciembre de 2016, que desarrollaron ICD. Los controles procedían de la misma población, con sospecha clínica de ICD y toxina CD(−). Se analizaron 82 variables.

Resultados

Fueron evaluados 17 casos y 95 controles, sin diferencias por sexo, edad o comorbilidad. Se registró diarrea en el 94% y 92%, y un porcentaje de exitus del 18% y 1%, respectivamente (p=0,001). La hemiplejia/paraplejia se asoció significativamente con la ICD (odds ratio [OR] ajustada=26,4; IC 95%: 2,9-235,6; p=0,003), mientras que la enfermedad respiratoria crónica y el uso de cefalosporinas presentaron una significación marginal (OR ajustadas de 2,9 [0,8-10,3] y 3,1 [0,8-11,3], ambas p=0,08).

Conclusiones

Las acciones en el SHD frente a la ICD deberían incluir una reducción en el uso de antibióticos de riesgo—según lo observado, las cefalosporinas—especialmente ante ciertas comorbilidades, como una hemiplejia/tetraplejia o una enfermedad respiratoria crónica.

Palabras clave:
Clostridium difficile
Hospitalización domiciliaria
Factores de riesgo
Mortalidad
Uso antibiótico

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