TY - JOUR
T1 - Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile
AU - Hernández-Rocha, Cristian
AU - Ajenjo, M. Cristina
AU - Quera, Rodrigo
AU - Quintanilla, Marcela
AU - Lubascher, Jaime
AU - Jemenao, M. Irene
AU - Ibáñez, Patricio
AU - Álvarez-Lobos, Manuel
AU - Diomedi, Alexis
AU - Marcotti, Alejandra
AU - Acuña, Mirta
AU - Arab, Juan P.
AU - Riquelme, Arnoldo
AU - Candia, Roberto
AU - Carvajal, Sergio
N1 - Publisher Copyright:
© 2016, Sociedad Chilena de Infectologia. All Rights Reserved.
PY - 2016/2
Y1 - 2016/2
N2 - Background: Clostridium difficile-associated diarrhea (CDAD) has become very important due to the increase in its incidence, severity, recurrence and the associated economic burden. Having a national consensus guideline is essential to improve its management. Objective: To build a multidisciplinary and evidence-based consensus in prevention, diagnosis and treatment of CDAD. Methods: We convened a panel of experts in the field of infectious diseases, gastroenterology, evidence-based medicine and consensus methodology. The panel conducted a structured review of published literature in CDAD evaluating evidence levels and recommendation degree according to the methodology proposed by the GRADE working-group. A modified three-round Delphi technique was used to reach a consensus among the experts. Results: A group of 16 experts was established, 12 of them answered 18 clinically relevant questions. The levels of agreement achieved by the panel of 16 experts were 79% in the first round and 100% in the second and third round. The main consensus recommendations in prevention are: Restricting the use of proton-pump inhibitors, primary prophylaxis with probiotics in antibiotics users, education of health personnel, isolation for patients hospitalized with CDAD, and cleaning the rooms exposed to C. difficile with products based in chlorine or hydrogen peroxide. In the diagnosis: use of biology molecular-based techniques is preferred and if not available, glutamate dehydrogenase-based algorithms may be recommended. With regard to treatment: the use of oral metronidazole in mild-moderate CDAD and oral vancomycin in severe CDAD are recommended. Treat the first recurrence with the same antibiotics according to severity. In the case of second and subsequent recurrences consider prolonged therapy with vancomycin, rifaximin or fecal microbiota transplant. Conclusion: The first Chilean consensus on prevention, diagnosis and treatment of CDAD is presented, which is a major step in improving national standards in the management of this disease.
AB - Background: Clostridium difficile-associated diarrhea (CDAD) has become very important due to the increase in its incidence, severity, recurrence and the associated economic burden. Having a national consensus guideline is essential to improve its management. Objective: To build a multidisciplinary and evidence-based consensus in prevention, diagnosis and treatment of CDAD. Methods: We convened a panel of experts in the field of infectious diseases, gastroenterology, evidence-based medicine and consensus methodology. The panel conducted a structured review of published literature in CDAD evaluating evidence levels and recommendation degree according to the methodology proposed by the GRADE working-group. A modified three-round Delphi technique was used to reach a consensus among the experts. Results: A group of 16 experts was established, 12 of them answered 18 clinically relevant questions. The levels of agreement achieved by the panel of 16 experts were 79% in the first round and 100% in the second and third round. The main consensus recommendations in prevention are: Restricting the use of proton-pump inhibitors, primary prophylaxis with probiotics in antibiotics users, education of health personnel, isolation for patients hospitalized with CDAD, and cleaning the rooms exposed to C. difficile with products based in chlorine or hydrogen peroxide. In the diagnosis: use of biology molecular-based techniques is preferred and if not available, glutamate dehydrogenase-based algorithms may be recommended. With regard to treatment: the use of oral metronidazole in mild-moderate CDAD and oral vancomycin in severe CDAD are recommended. Treat the first recurrence with the same antibiotics according to severity. In the case of second and subsequent recurrences consider prolonged therapy with vancomycin, rifaximin or fecal microbiota transplant. Conclusion: The first Chilean consensus on prevention, diagnosis and treatment of CDAD is presented, which is a major step in improving national standards in the management of this disease.
KW - Clostridium difficile
KW - Consensus
KW - Diagnosis
KW - Evidence-based medicine
KW - Practice guideline
KW - Prevention and control
KW - Review
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=84960355962&partnerID=8YFLogxK
U2 - 10.4067/S0716-10182016000100020
DO - 10.4067/S0716-10182016000100020
M3 - Article
C2 - 26965890
AN - SCOPUS:84960355962
SN - 0716-1018
VL - 33
SP - 98
EP - 118
JO - Revista Chilena de Infectologia
JF - Revista Chilena de Infectologia
IS - 1
ER -