title: [Chilean consensus of prevention, diagnosis and treatment of Clostridium difficile-associated diarrhea].
abstract: BACKGROUND
  Clostridium dijfficile-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.
  
  
  CONCLUSIONS
  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.
authors.forename: Cristian
authors.initials: C
authors.lastname: Hernández-Rocha
authors.forename: Paola
authors.initials: P
authors.lastname: Pidal
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Ajenjo
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Quera
authors.forename: Marcela
authors.initials: M
authors.lastname: Quintanilla
authors.forename: Jaime
authors.initials: J
authors.lastname: Lubascher
authors.forename: M Irene
authors.initials: MI
authors.lastname: Jemenao
authors.forename: Patricio
authors.initials: P
authors.lastname: Ibáñez
authors.forename: Manuel
authors.initials: M
authors.lastname: Álvarez-Lobos
authors.forename: Alexis
authors.initials: A
authors.lastname: Diomedi
authors.forename: Alejandra
authors.initials: A
authors.lastname: Marcotti
authors.forename: Mirta
authors.initials: M
authors.lastname: Acuña
authors.forename: Juan P
authors.initials: JP
authors.lastname: Arab
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Riquelme
authors.forename: Roberto
authors.initials: R
authors.lastname: Candía
authors.forename: Sergio
authors.initials: S
authors.lastname: Carvajal
mesh_terms: D002677:Chile; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D003967:Diarrhea / Q000382:microbiology*; D006801:Humans