Consenso chileno de prevención, diagnóstico y tratamiento de la diarrea asociada a Clostridium difficile

Cristian Hernández-Rocha, M. Cristina Ajenjo, Rodrigo Quera, Marcela Quintanilla, Jaime Lubascher, M. Irene Jemenao, Patricio Ibáñez, Manuel Álvarez-Lobos, Alexis Diomedi, Alejandra Marcotti, Mirta Acuña, Juan P. Arab, Arnoldo Riquelme, Roberto Candia, Sergio Carvajal*

*Autor correspondiente de este trabajo

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

10 Citas (Scopus)

Resumen

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.

Título traducido de la contribuciónChilean consensus of prevention, diagnosis and treatment of Clostridium difficile-associated diarrhea
Idioma originalEspañol
Páginas (desde-hasta)98-118
Número de páginas21
PublicaciónRevista Chilena de Infectologia
Volumen33
N.º1
DOI
EstadoPublicada - feb. 2016
Publicado de forma externa

Nota bibliográfica

Publisher Copyright:
© 2016, Sociedad Chilena de Infectologia. All Rights Reserved.

Palabras clave

  • Clostridium difficile
  • Consensus
  • Diagnosis
  • Evidence-based medicine
  • Practice guideline
  • Prevention and control
  • Review
  • Therapy

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