<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0186-4866</journal-id>
<journal-title><![CDATA[Medicina interna de México]]></journal-title>
<abbrev-journal-title><![CDATA[Med. interna Méx.]]></abbrev-journal-title>
<issn>0186-4866</issn>
<publisher>
<publisher-name><![CDATA[Edición y Farmacia S.A. de C.V.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0186-48662018000100003</article-id>
<article-id pub-id-type="doi">10.24245/mim.v34i1.1921</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Diarrea por Clostridium difficile en pacientes hospitalizados]]></article-title>
<article-title xml:lang="en"><![CDATA[Diarrhea due to Clostridium difficile in hospitalized patients]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez-Rodríguez]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Estrada-Hernández]]></surname>
<given-names><![CDATA[LO]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tomé-Sandoval]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Salazar-Salinas]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,UNAM Facultad de Estudios Superiores Zaragoza ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Regional Lic. Adolfo Lopez Mateos  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Regional Lic. Adolfo Lopez Mateos  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
</aff>
<aff id="Af4">
<institution><![CDATA[,Hospital Regional Lic. Adolfo Lopez Mateos  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>02</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>02</month>
<year>2018</year>
</pub-date>
<volume>34</volume>
<numero>1</numero>
<fpage>9</fpage>
<lpage>18</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0186-48662018000100003&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0186-48662018000100003&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0186-48662018000100003&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  ANTECEDENTES: La infección por Clostridium difficile es la causa más importante de enfermedad gastrointestinal relacionada con el sistema hospitalario que conlleva alta morbilidad y mortalidad y costos estimados en 3.2 mil millones de dólares anualmente.  OBJETIVO: Conocer el comportamiento de la diarrea intrahospitalaria por C. difficile, así como las características de la enfermedad y de los pacientes.  MATERIAL Y MÉTODO: Estudio longitudinal, efectuado del 1 de julio de 2015 al 30 de abril de 2016, en el que se incluyeron los casos de diarrea intrahospitalaria atendidos en todos los servicios del Hospital Regional Lic. Adolfo López Mateos, Ciudad de México. Con el apoyo del Laboratorio de Vigilancia Epidemiológica del ISSSTE, ubicado en el Centro Médico Nacional 20 de Noviembre, a todos los casos se les realizó prueba de inmunoensayo para la identificación de toxinas A, B o ambas.  RESULTADOS: Se identificaron 220 casos de diarrea intrahospitalaria en el periodo de estudio, de los que 106 (48.2%) resultaron positivos a la prueba de inmunoensayo para toxinas A, B (o ambas) de C. difficile y correspondieron a los servicios de Medicina Interna, Cirugía General y Unidad de Cuidados Intensivos. Se realizó seguimiento a 100 pacientes de los que 75 fueron dados de alta y 25 fallecieron (tasa de mortalidad de 25%). El servicio en el que se identificaron más casos fue Medicina Interna con 58 (54.7%), seguido de Cirugía General con 14 (13.2%) y de Ortopedia con 10 (10.6%). Los 106 pacientes incluidos que resultaron positivos habían recibido durante su estancia hospitalaria y antes de manifestar el cuadro diarreico al menos un antimicrobiano, 41.4% monoterapia y 58.6% dos o más antibióticos. El antibiótico más frecuente en los casos de monoterapia fue ceftriaxona (50%), seguido de meropenem (20.6%) y en los casos de combinaciones se observó una variedad de ellas. La mediana de días de estancia hospitalaria en los pacientes que fallecieron fue de 24 días (intervalo: 5-112) y en los que fueron dados de alta la mediana fue de 20 días (intervalo: 2-85).  CONCLUSIONES: Este estudio aporta información muy similar a la reportada en las escasas publicaciones mexicanas referidas en este trabajo en cuanto a los factores de riesgo, variabilidad de las manifestaciones clínicas, oportunidad del tratamiento, evidencia, consecuencias de la administración indiscriminada de antibióticos con fines profilácticos, terapéuticos o ambos y necesidad del tratamiento multidisciplinario de los pacientes con enfermedad grave o severa. Destaca también la participación de los bloqueadores H2 como un importante factor de riesgo encontrado en más de 70% de los casos y la administración de mesalazina y probióticos como coadyuvantes en el tratamiento.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  BACKGROUND: Infection due to Clostridium difficile is the most important cause of gastrointestinal disease related to the hospitality system leading to high morbidity and mortality and costs estimated in 3.2 billion dollars each year.  OBJECTIVE: To know the behavior of intrahospitalary diarrhea due to C. difficile, as well as the characteristics of the disease and patients.  MATERIAL AND METHOD:  A longitudinal study done from July 1st 2015 to April 30 2016, in which cases of intrahospitalary diarrhea attended in all services of the Reginal Hospital Lic. Adolfo López Mateos, Mexico City, were included. With the support of the Laboratory of Epidemiological Surveillance of ISSSTE, at Centro Médico Nacional 20 de Noviembre, Mexico City, all cases were submitted to immunoassay test to the identification of toxins A, B or both.  RESULTS: There were identified 220 cases of intrahospitalary diarrhea in the study period, from which 106 (48.2%) were positive to immunoassay test for toxins A, B (or both) of C. difficile and corresponded to services of Internal Medicine, General Surgery and Intensive Care Unit. One hundred patients were followed, from which 75 were discharged and 25 died (mortality rate of 25%). Service in which most cases were identified was Internal Medicine with 58 (54.7%), followed by General Surgery with 14 (13.2%) and Orthopedics with 10 (10.6%). The 106 patients included that resulted positive had received during their hospitalization and before presenting diarrhea at least one antimicrobial, 41.4% monotherapy and 58.6% two or more antimicrobials. The most frequently prescribed antibiotic in cases of monotherapy was ceftriaxone (50%), followed by meropenem (20.6%) and in all cases of combinations it was observed a variety of them. The mean days of hospitalization of patients who died was of 24 days (range: 5-112) and of discharged patients was of 20 days (range: 2-85).  CONCLUSIONS: This study gives information very similar to that reported in the little Mexican publications referred in this paper about risk factors, variability of clinical manifestations, opportunity of treatment, evidence, consequences of the indiscriminate administration of antibiotics with prophylactic and/or therapeutic objectives and the need of multidisciplinary treatment of patients with severe disease. It is also highlighted the participation of H2 blockers as an important risk factor found in more than 70% of cases and the administration of mesalazine and probiotics as adjuvant in the treatment.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Diarrea]]></kwd>
<kwd lng="es"><![CDATA[Clostridium difficile.]]></kwd>
<kwd lng="en"><![CDATA[Diarrhea]]></kwd>
<kwd lng="en"><![CDATA[Clostridium difficile]]></kwd>
</kwd-group>
</article-meta>
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