title: Clinical and endoscopic features in patients with hospital-acquired diarrhea associated with Clostridium difficile infection.
abstract: OBJECTIVE
  Clostridium difficile infection is the main cause of hospital-acquired diarrhea, and the clinical and endoscopic findings in those patients have been studied very little in Mexico. The aim of the present study was to describe those findings.
  
  
  METHODS
  A prospective cohort study was conducted that included patients with hospital-acquired diarrhea associated with Clostridium difficile diagnosed through polymerase chain reaction. The hypervirulent NAP027 strain was also determined. The clinical and endoscopic findings in the study patients, as well as the variables associated with severity, were analyzed.
  
  
  RESULTS
  Of the 127 patients with hospital-acquired diarrhea, 97 were excluded from the study due to lack of colonoscopy. The remaining 39 study patients had a mean age of 48 years, and their most common signs/symptoms were abdominal pain (49%), mucus in stools (41%), and blood in stools (10%). The most common alterations in the laboratory results were leukocytosis in 49%, fecal leukocytes (61%), and hypoalbuminemia (67%). The main risk factor was antibiotic use in 62%, and ceftriaxone was the most widely used. The hypervirulent strain was present in 54% of the cases. Endoscopic abnormalities were found in 87% of the patients. Thirty-eight percent presented with pseudomembranous colitis, with lesions in the left colon in 53%, and in the right colon in 13%. No association was found between proton-pump inhibitor use and Clostridium difficile-associated diarrhea. There was a significant association between hypoalbuminemia (< 3.3g/dL) and a greater risk for severe colitis, with a RR of 8.2 (p=0.008).
  
  
  CONCLUSIONS
  Pseudomembranous colitis lesions associated with the hypervirulent Clostridium difficile strain were predominant in the left colon. Hypoalbuminemia was a significant severity predictor.
authors.affiliation: Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México. Electronic address: velardemd@yahoo.com.mx.
authors.forename: J A
authors.initials: JA
authors.lastname: Velarde Ruiz-Velasco
authors.affiliation: Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: J M
authors.initials: JM
authors.lastname: Aldana-Ledesma
authors.affiliation: Servicio de Terapia Intensiva, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: M A
authors.initials: MA
authors.lastname: Ibarra-Estrada
authors.affiliation: Servicio de Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: S A
authors.initials: SA
authors.lastname: Aguirre Díaz
authors.affiliation: Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
authors.forename: J A
authors.initials: JA
authors.lastname: Fernández-Ramírez
authors.affiliation: Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
authors.forename: F
authors.initials: F
authors.lastname: Cárdenas-Lara
authors.affiliation: Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: F
authors.initials: F
authors.lastname: Álvarez López
authors.affiliation: Servicio de Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: L E
authors.initials: LE
authors.lastname: Rodríguez-Noriega
authors.affiliation: Servicio de Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
authors.forename: H R
authors.initials: HR
authors.lastname: Pérez-Gómez
authors.affiliation: Servicio de Infectología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México; Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
authors.forename: M R
authors.initials: MR
authors.lastname: Morfín-Otero
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000145:classification; D003015:Clostridium Infections / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D003967:Diarrhea / Q000000981:diagnostic imaging / Q000382:microbiology*; D016099:Endoscopy, Gastrointestinal; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cepa NAP027; Clostridium difficile; Colitis seudomembranosa; Colonoscopia; Colonoscopy; NAP027 strain; Pseudomembranous colitis