Bacteriemia por Clostridiodes difficile. Primer caso reportado en México. (Spanish)

Clostridiodes difficile bacteremia. First mexican case report. (English)

Background: Clostridiodes difficile bacteremia (CDB) develops in less than 1% of all the cases, nonetheless, with a significant increase in mortality. The objective of the present article is to report the first case of CDB in the Mexican population, empathizing with the treatment difficulty derived from the lack of consensus. Clinical case: A 42-year-old female with previous history of chronic thromboembolic pathologies and grade III obesity, develops community acquired atypical pneumonia requiring hospitalization, having parenteral antibiotics. During hospitalization, non severe C. difficile infection was concluded and started treatment with Vancomycin for 10 days. One week later the patient presented to the emergency department at HES CMN SXXI with gastrointestinal symptomatology, mostly epigastric pain, fever and diarrhea. After proper approach, C. difficile was isolated in blood cultures through mass spectrophotometry analysis, for which a 10- day treatment of metronidazole was prescribed with resolution of the infection being discharged afterwards. Conclusion: CDB is an exceptional and lethal clinical condition, mainly seen in patients with previous gastrointestinal diseases. IV Metronidazole demonstrated therapeutic effi- cacy in this case report and could be a successful and available therapeutic option in Mexican health care units. [ABSTRACT FROM AUTHOR]

Introducción: la bacteriemia por Clostridiodes difficile (BCD) se presenta en menos del 1% de los casos, sin embargo, con un importante incremento de la mortalidad. El objetivo de este reporte es reportar el primer caso de BCD en México, enfatizando la falta de directrices en el tratamiento. Caso clínico: paciente mujer de 42 años con antecedente de obesidad mórbida y procesos trombóticos crónicos, quien es hospitalizada con sospecha de proceso neumónico atípico adquirido en la comunidad, recibiendo múltiples regímenes de antibioticoterapia, con posterior infección por Clostridiodes sin datos de severidad. Se le ofrece tratamiento completo oral a base de vancomicina con mejoría; sin embargo, presenta recaída y es ingresada en Hospital de Especialidades del Centro Médico Nacional Siglo XXI con sintomatología (dolor abdominal, evacuaciones diarreicas y fiebre). Durante su evaluación se identifica la presencia C. difficile en sangre mediante espectrofotometría de masas, iniciándose tratamiento a base de metronidazol intravenoso durante 10 días con adecuada evolución y sin nuevas recaídas. Conclusión: la BCD es una presentación clínica excepcional, presentándose particularmente en pacientes con trastornos gastrointestinales preexistentes. El metronidazol IV demostró eficacia terapéutica en el presente caso, por lo que podría considerarse como una opción terapéutica eficaz y ampliamente disponible en las unidades hospitalarias de México. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)