title: [Outbreak of nosocomial diarrhea by Clostridium difficile in a department of internal medicine].
abstract: BACKGROUND
  Clostridium difficile (DCD) is the main etiologic agent of nosocomial diarrhea of infectious origin. Most of the cases of DCD have been detected in a hospital environment.
  
  
  METHODS
  From October to November 1996 five cases of nosocomial diarrhea were detected with the presence of the toxin A of Clostridium difficile being observed in the stools. These patients were compared with a group of 19 patients without diarrhea (controls) who were admitted to the same ward during the same period as the patients with DCD.
  
  
  RESULTS
  The hospital stay of the cases was greater (25 +/- 8 days) than that of the controls (14 +/- 10 days; p < 0.05). One hundred percent of the cases received antibiotics during admission (2 +/- 1.2 antibiotics per patient), versus 68% of the controls (1.1 +/- 0.9 antibiotics per patient, p > 0.05). The length of antibiotic treatment prior to the onset of the symptoms was 8 +/- 3 days (range 7-11 days). The type of antibiotic administered was similar in both groups. More of the cases with DCD (60%) had vesicle catheterization than the controls (11%, p < 0.05). All the patients with DCD presented abdominal pain and several liquid stools per day without blood or pus (3.2 +/- 0.45 stools per patient) and 2 (40%) fever. The mean length of diarrhea was 5.6 +/- 3.6 days. The serum albumin concentration on the first day of admission was significantly lower in the cases of DCD (2.9 +/- 0.4 mg/dl) than in the controls (3.3 +/- 3.4 mg/dl, p < 0.05). All the cases received antibiotic treatment for Clostridium difficile (oral metronidazol or vancomycin) with good clinical evolution.
  
  
  CONCLUSIONS
  The patients with DCD had more often had vesicle catherization and presented a lower serum albumin concentration than the controls.
authors.affiliation: Servicio de Medicina Interna III, Clínica Puerta de Hierro, Madrid.
authors.forename: A
authors.initials: A
authors.lastname: Ramos
authors.forename: T
authors.initials: T
authors.lastname: Gazapo
authors.forename: J
authors.initials: J
authors.lastname: Murillas
authors.forename: J L
authors.initials: JL
authors.lastname: Portero
authors.forename: A
authors.initials: A
authors.lastname: Valle
authors.forename: F
authors.initials: F
authors.lastname: Martín
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
vernacular_title: Brote de diarrea nosocomial por Clostridium difficile en un servicio de medicina interna.