Infección recurrente por Clostridium difficile en pediatría. Reporte de dos casos y revisión de la literatura
DOI:
https://doi.org/10.22516/25007440.75Keywords:
Clostridium difficile, pediatría, antibacterianos, diarreaAbstract
Antecedente: el uso indiscriminado de antibióticos no solo se relaciona con la resistencia, sino también con el aumento de algunas infecciones bacterianas, como es el caso de Clostridium difficile (CD). A pesar de un tratamiento adecuado, estas infecciones presentan una alta tasa de recurrencia, por lo que es necesario contar con pautas adecuadas de manejo y seguimiento. Metodología: se hace la presentación de 2 pacientes en edad pediátrica con episodios de reinfección por CD, manejados en la unidad de gastroenterología, hepatología y nutrición pediátrica, Gastronutriped (Bogotá, Colombia), así como una actualización en la identificación de factores de riesgo, diagnóstico y tratamiento de la infección recurrente por CD. Conclusiones: los casos de infección por CD presentan un reto en la población pediátrica por la similitud con cuadros infecciosos; la presencia de deposiciones sanguinolentas con el antecedente de consumo previo de antibiótico deben hacer sospechar la infección. Los casos de reinfección pueden presentarse hasta 3 meses luego del cuadro inicial; el manejo de la primera reinfección en casos leves no requiere de antibiótico, pero en casos moderados o severos se puede dar el mismo tratamiento inicial (metronidazol), en caso de una segunda reinfección se debe utilizar vancomicina, en caso de 3 o más episodios todavía hay discusiones en cuál es el tratamiento más adecuado. En los últimos años, se ha visto que el uso de probióticos y el trasplante de microbiota fecal han mostrado mayores beneficios en el cuadro de reinfección, aunque la evidencia disponible todavía es no concluyente.Downloads
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