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Multicenter study on Clostridioides difficile infections in Mexico: exploring the landscape

Published online by Cambridge University Press:  21 October 2024

Daniel De-la-Rosa-Martinez Open the ORCID record for Daniel De-la-Rosa-Martinez [Opens in a new window] ,
Diana Vilar-Compte Open the ORCID record for Diana Vilar-Compte [Opens in a new window] ,
Nancy Martínez-Rivera Open the ORCID record for Nancy Martínez-Rivera [Opens in a new window] ,
Eric Ochoa-Hein Open the ORCID record for Eric Ochoa-Hein [Opens in a new window] ,
Rayo Morfin-Otero Open the ORCID record for Rayo Morfin-Otero [Opens in a new window] ,
María Esther Rangel-Ramírez ,
Pamela Garciadiego-Fossas Open the ORCID record for Pamela Garciadiego-Fossas [Opens in a new window] ,
Juan Luis Mosqueda-Gómez Open the ORCID record for Juan Luis Mosqueda-Gómez [Opens in a new window] ,
Ana Patricia Rodríguez Zulueta Open the ORCID record for Ana Patricia Rodríguez Zulueta [Opens in a new window]  and
Isaí Medina-Piñón Open the ORCID record for Isaí Medina-Piñón [Opens in a new window]
...Show all authors
Daniel De-la-Rosa-Martinez
Affiliation:
Instituto Nacional de Cancerología, Mexico City, Mexico F. I. Proctor Foundation, University of California San Francisco, San Francisco, USA
Diana Vilar-Compte
Affiliation:
Instituto Nacional de Cancerología, Mexico City, Mexico
Nancy Martínez-Rivera
Affiliation:
Instituto Nacional de Cancerología, Mexico City, Mexico
Eric Ochoa-Hein
Affiliation:
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Rayo Morfin-Otero
Affiliation:
Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
María Esther Rangel-Ramírez
Affiliation:
Hospital General “Dr. Agustín O’Horán”, Mérida, Mexico
Pamela Garciadiego-Fossas
Affiliation:
Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
Juan Luis Mosqueda-Gómez
Affiliation:
Hospital Regional de Alta Especialidad del Bajío, Servicios de Salud del Instituto Mexicano de Seguro Social para el Bienestar (IMSS-BIENESTAR), Guanajuato, Mexico
Ana Patricia Rodríguez Zulueta
Affiliation:
Hospital General “Dr. Manuel Gea González”, Mexico City, Mexico
Isaí Medina-Piñón
Affiliation:
Christus Muguerza Hospital del Parque, Chihuahua, Mexico
Rafael Franco-Cendejas
Affiliation:
Instituto Nacional de Rehabilitación, Mexico City, Mexico
Christian Gerardo Alfaro-Rivera
Affiliation:
Hospital Ángeles del Carmen, Guadalajara, Mexico
Norma Eréndira Rivera-Martínez
Affiliation:
Hospital Regional de Alta Especialidad de Oaxaca, Servicios de Salud del Instituto Mexicano de Seguro Social para el Bienestar (IMSS-BIENESTAR), Oaxaca, Mexico
Jonathan Mendoza-Barragán
Affiliation:
Hospital Ángeles Chihuahua, Chihuahua, Mexico
Alicia Estela López-Romo
Affiliation:
Christus Muguerza Hospital Alta Especialidad, Monterrey, Mexico
Marisol Manríquez-Reyes
Affiliation:
Hospital Español de Veracruz, Veracruz, Mexico
David Humberto Martínez-Oliva
Affiliation:
Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
Samantha Flores-Treviño
Affiliation:
Hospital Universitario “Dr. José Eleuterio González”, Monterrey, Mexico
Jhoan M Azamar-Marquez
Affiliation:
Hospital Universitario “Dr. José Eleuterio González”, Monterrey, Mexico
Lirio Nathali Valverde-Ramos
Affiliation:
Hospital General “Dr. Manuel Gea González”, Mexico City, Mexico
José Raúl Nieto-Saucedo
Affiliation:
Hospital Regional de Alta Especialidad del Bajío, Servicios de Salud del Instituto Mexicano de Seguro Social para el Bienestar (IMSS-BIENESTAR), Guanajuato, Mexico
Sara Alejandra Aguirre-Díaz
Affiliation:
Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Mexico
Adrián Camacho-Ortiz*
Affiliation:
Hospital Universitario “Dr. José Eleuterio González”, Monterrey, Mexico
*
Corresponding author: Adrián Camacho-Ortiz; Email: [email protected]
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Abstract

Objective:

This study aims to outline Clostridioides difficile infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic.

Design:

Observational study of case series.

Setting:

Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022.

Patients:

CDI patients.

Methods:

Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression.

Results:

We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals.

Conclusions:

Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 12 , December 2024 , pp. 1420 - 1427
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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