RESUMO
BACKGROUND: The epidemiology of Clostridium difficile infections (CDI) is changing rapidly worldwide; knowledge on the genotypes of C. difficile circulating in specialized geriatric hospitals and their resistance to antibiotics is scarce or non-existent. METHODS: Prospective study of the molecular epidemiology of CDI, conducted in a national geriatric hospital in Costa Rica for a period of 11 months. RESULTS: The study patients exhibited a diverse range of comorbidities, but none were associated with CDI. Polyclonality, including three new ribotypes, and a high level of resistance to antibiotics were determined by analysing the 32 isolates obtained in these cases. Despite the diversity in strains observed, the most frequent types were NAP6/RT002 and NAP2/RT001. NAP9/RT017 was associated with community acquisition. Nineteen types of antimicrobials were used before the onset of diarrhoea in the patients; no particular genotype was associated with the onset of infection or severity. CONCLUSION: Based on the abundance of strain types observed and their resistance to antibiotics in this geriatric hospital, these results contribute to a better overall understanding of the epidemiology of CDI worldwide, and to surveillance programmes targeting geriatric populations.
Assuntos
Clostridioides difficile/classificação , Clostridioides difficile/genética , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Variação Genética , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Clostridioides difficile/isolamento & purificação , Costa Rica/epidemiologia , Diarreia/epidemiologia , Diarreia/microbiologia , Farmacorresistência Bacteriana , Feminino , Hospitais , Humanos , Masculino , Epidemiologia Molecular , Estudos Prospectivos , RibotipagemRESUMO
Randomized clinical trials without statistically significant differences between treatment groups may provide useful information for clinicians. However, negative trials must be interpreted cautiously, since the absence of evidence of treatment effect is not the same as evidence of absence of treatment effect. Before the reader of a negative article can conclude that one intervention was not better than the other, the potential causes of a negative study should be explored. The objective of this manuscript is to critically describe some of the most common methodological problems that can explain the lack of difference between studied groups in randomized clinical trials.
Assuntos
Interpretação Estatística de Dados , Ensaios Clínicos Controlados Aleatórios como Assunto/métodosRESUMO
Se presentan los conocimientos y actitudes de una muestra de madres que acudió al Hospital de niños de Santo Domingo, en demanda de atención médica para sus hijos enfermos de infección Respiratoria Aguda, encontrándose una falta de información y conocimientos sobre las IRA en una proporción significativamente importante (p<0.001) de esas madres. Se destaca la tardanza en la búsqueda de asistencia médica, el tratamiento casero y el cumplimiento de la terapia como factores que agravan la enfermedad. Por último, se resalta el tabaquismo amplificado por la contaminación doméstica, por la promiscuidad y la exigüedad de las habitaciones como factores coadyuvantes de las IRA; puntualizándose el desconocimiento materno del rol nocivo que estos factores representan.