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Eduardo Garcia Vilelahttp://lattes.cnpq.br/2200958917077252Rodrigo Otávio Silveira SilvaLuiz Gonzaga Vaz CoelhoLigia Yukie Sassakihttp://lattes.cnpq.br/7212245447763077Fernando Antônio Castro Carvalho2022-04-11T14:41:08Z2022-04-11T14:41:08Z2021-03-25http://hdl.handle.net/1843/40974Introdução: a infecção pelo Clostridioides difficile (ICD) a principal causa de diarreia associada a cuidados de saúde. O surgimento de estirpes hipervirulentas a partir dos anos 2000 em pa ses desenvolvidos foi responsável pelo aumento da incidência, da gravidade e da mortalidade relacionada a infecção e motivou estudos de vigilância, visando melhor controle e manejo dessa afecção. Objetivos: avaliar o perfil evolutivo da ICD no que tange seus critérios de gravidade, recorrência, tempo de internação hospitalar e óbito e caracterizar seus ribotipos (RT). Pacientes e métodos: foram incluídos 65 pacientes com ICD confirmada por meio de testes de detecção das toxinas A e B ou cultura toxigênica e feita pesquisa do gene produtor de toxina binária nas amostras de fezes. A ribotipagem foi realizada em 44 estirpes bacterianas. Os pacientes foram avaliados em relação aos aspectos demográficos, clínicos, laboratoriais e em relação aos critérios de gravidade. Resultados: 34 pacientes eram do sexo masculino e 31 do sexo feminino. A mediana de idade foi de 59 (20 – 87) anos. Ocorreram 16 óbitos (24,6%) durante o período de internação. A mediana do índice de comorbidades de Charlson (ICC) foi de 4 (0 -15) e a pontuação ≥ 8 esteve presente em 11 pacientes (16,9%). Dentre as comorbidades, as doenças neoplásicas foram as mais prevalentes e estiveram presentes em 29 pacientes (44,6%) e as doenças cardiovasculares em 23 (35,4%). Quatorze pacientes (21,5%) haviam sido submetidos a transplantes previamente e, apenas um paciente não fez uso antibióticos (ATB) nos três meses que antecederam o diagnóstico. A recorrência esteve associada ao ICC > 7 (OR = 24,52, IC 95% 1,67 – 360,22). O maior período de internação hospitalar esteve relacionado aos múltiplos cursos de ATB (OR = 1,64, IC 95% 1,29 – 1,82) e à necessidade de nutrição enteral (OR = 1,66, IC 95% 1,36 – 1,82). O período de internação entre o diagnóstico da ICD e a alta foi maior entre os pacientes que fizeram uso de múltiplos cursos de ATB (OR = 1,58, IC 95% 1,13 – 1,80), início de novo antibiótico após o diagnóstico (OR = 1,75, IC 95% 1,48 – 1,88) e internação em terapia intensiva (OR = 1,57, IC 95% 1,18 – 1,78). O escore de ATLAS (OR = 1,76, IC 95% 1,08 – 2,86) e a não melhora da diarreia (OR = 1,08, IC 95% 1,008 – 1,747) estiveram relacionados a maior mortalidade. Foram identificadas 8 estirpes produtoras de toxina binária. O ribotipo mais prevalente foi o 106 (43,2%), seguido pelo 014/020 (9,1%), sendo identificados 20 ribotipos diferentes. O RT 027 não foi isolado. A presença da toxina binária e os ribotipos não se relacionaram com desfechos estudados. Conclusão: ICD esteve presente em amostra de pacientes mais complexos, portadores de doenças mais graves. Foram identificados fatores associados a maior chance de morte, maior período de internação hospitalar e recorrência. Foi observada uma diversidade de ribotipos, ainda que o RT 106 tenha sido mais prevalente. A presença da toxina binária e as estirpes de C. difficile não se relacionaram aos desfechos estudados.Introduction: Clostridioides difficile infection (CDI) is the main cause of health careassociated diarrhea. The emergency of hypervirulent strains since the 2000s in developed countries has been responsible for the increasing incidence, severity and mortality related to the infection and has motivated the surveillance studies, aiming for better control and management of this disease. Objectives: assess the CDI evolutionary profile and characterize its ribotypes. Patients and methods: 65 patients whose diagnosis was confirmed by testing for toxins A and B and toxigenic culture performed in stool specimens were included. 44 bacterial strains were subjected to ribotyping and binary toxin gene search by the polymerase chain reaction. The patients were characterized in relation to demographics, clinical, laboratory aspects and severity criteria. Results: 34 patients were male and 31 were female. The age median was 59 (20-87) years old. There were 16 (24,6%) deaths during the period of hospitalization. The median of the Charlson Comorbidity Index was 4 (0-15). The score greater or equal to 8 was present in 16,9% of the sample (11 patients). Among the comborbities, the neoplasms were the most prevalent, present in 29 patients (44.6%), followed by cardiovascular diseases, in 23 patients (35.4%). Fourteen patients had been transplanted and only one patient had not been treated with antibiotics in the three months preceding the diagnosis. Recurrence was associated with the Charlson Comorbidity Index > 7 (OR = 24.52; IC 95% 1.67 – 360.22). The longer length of hospitalization was related to multiple antibiotics treatments (OR = 1.64; IC 95% 1.29 – 1.82) and to the need for enteral nutrition (OR = 1.66; IC 95% 1.36 – 1.82). The period of hospitalization between the CDI diagnosis and the hospital discharge was longer among the patients with multiple antibiotic treatments (OR = 1.58; IC 95% 1.13 – 1.80), new antibiotic after diagnosis (OR = 1.75; IC 95% 1.48 – 1.88) and need of intensive care unit (OR = 1.57; IC 95% 1.18 – 1.78). The ATLAS score (OR = 1.76; CI 95% 1.08 – 2.86) and the non improvement of the diarrhea (OR = 1.08; CI 95% 1.008 – 1.747) were related to a higher mortality. Eight binary toxin positive strains were identified. The most common ribotype (RT) was the 106 (43.2%), followed by 014/020 (9.1%), with 20 different ribotypes being identified. RT027 has not been isolated. The identification of the binary toxin and the type of C. difficile did not correlate with the studied outcomes. Conclusion: CDI was present in the samples of complex patients and carriers of severe diseases. Factors associated with a higher chance of death, longer hospitalization and recurrence were identified. A higher diversity of ribotypes was observed, although the RT106 was the most prevalent. The identification of the binary toxin and the type of C. difficile did not correlationate with the studied outcomes.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências Aplicadas à Saúde do AdultoUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICAInfecções por ClostridiumRecidivaMortalidadeInfecção por Clostridioides difficileRibotiposEscore de gravidade ATLASRecorrênciaMortalidadePerfil evolutivo e estudo ribotípico da infecção por Clostridioides (Clostridium) difficile em coorte de pacientes com diarreia internados no Hospital das Clínicas da UFMGEvolutionary profile and ribotype study of Clostridioides (Clostridium) difficile infection in a cohort of patients with diarrhea admitted to the Clinical Hospital of the Federal University of Minas Geraisinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALDissertação com ficha catalografica e ata final.pdfDissertação com ficha catalografica e ata final.pdfapplication/pdf2244197https://repositorio.ufmg.br/bitstream/1843/40974/3/Disserta%c3%a7%c3%a3o%20com%20ficha%20catalografica%20e%20ata%20final.pdfad6e35dfe29c846a63a87d378009aa6cMD53LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/40974/4/license.txtcda590c95a0b51b4d15f60c9642ca272MD541843/409742022-04-11 11:41:08.674oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-04-11T14:41:08Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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