Características clínicas y microbiológicas de las diarreas agudas en una unidad de corta estanciadesarrollo de un modelo predictivo de salmonella

Abstract

SUMMARY Introduction: Acute diarrhea is a major clinical problem due to its frequency and its possible complications. It is one of the five leading causes of death in the world, it is responsible for approximately two million deaths annually. It is essential for the proper management a correct electrolyte replacement therapy and empirical antibiotics when they are indicated according to the suspected microorganism. In cases where diarrhea is caused by Salmonella, which is the most frequent cause of hospitalization for acute gastroenteritis, does not require antibiotic administration except in selected cases, antibiotic treatment increases the likelihood of making the patient bearer, increases the risk of transmission in the community and antibiotic treatment increase the emergence of resistances. This study is important because in our area there are few studies of etiology of acute diarrhea in adults and have never done predictive etiological models in acute diarrhea. Objectives: First analyze the characteristics of acute diarrhea admitted to the Short Stay Unit of Hospital Clínico Universitario Virgen de la Arrixaca over a period of two years. Second we investigate which of these variables are associated with the isolation of Salmonella, Campylobacter, and the negative results of stool culture. Finally conduct a predictive model of Salmonella which help us in the decision to start or not an empirical antibiotic treatment. Methods: First we conducted a prospective study of 210 cases of acute diarrhea admitted to the Short Stay Unit of the Hospital Clínico Universitario Virgen de la Arrixaca of Murcia for a period of two years, and described the epidemiological, clinical and microbiologic characteristics. Second, the variables that were associated with the isolation of Salmonella, Campylobacter, and the negative results of culture tests using binary logistic regression were investigated. Subsequently, a predictive model of Salmonella was conducted. Results: A total of 210 patients were included in the study. The stool culture was positive in 89 cases (42,4%), Salmonella was isolated in 53 (25,2%), Campylobacter was isolated in 31 (14,8%), Clostridium difficile in 3 (1,4%), and Shigella in 2 cases (1%). It was found that the epidemiological variables eggs consumption and others affected, clinical variables presence of fever, abdominal pain and green stools are associated with isolation of Salmonella in stool culture. With these variables was obtained a predictive model that helps us in the decision to start or not an empirical antibiotic treatment. Epidemiological and clinical variables were included in our model to make easier its implementation in daily practice. With this model we can predict with a probability of up to 84% the isolation of Salmonella. A model predictive with Campylobacter was not performed because only found a variable that is associated with its isolation in the stool. Keywords: gastroenteritis, diarrhea, Salmonella, Campylobacter.