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Introducción. La implicación de los médicos asistenciales en tareas de investigación clínica presenta grandes diferencias entre las diversas instituciones Material y método. Estudio transversal basado en una encuesta enviada a los miembros del Grupo de Trabajo de Enfermedades Infecciosas (GTei) de la Sociedad Española de Medicina Interna (SEMI) durante el mes de mayo de 2022 Resultados. De 1.789 miembros del GTei, 169 miembros (9,45%) cumplimentaron la encuesta. La percepción de la conveniencia de participación de cada facultativo en una o varias líneas de investigación fue de 8 puntos (P25:7; P75: 9 puntos). La percepción sobre el estímulo para investigar del sistema sanitario o de la dirección del hospital fue de 2 puntos (1-4), respectivamente. El apoyo a la investigación fue valorado con de 5 (2-7) y 6 (3-7) puntos en relación con el jefe de servicio y los compañeros del departamento, respectivamente. Otros factores evaluados fueron la falta de tiempo por no poder reducir la actividad asistencial (9; 7-10 puntos), la priorización de las actividades de ocio durante el tiempo libre disponible (7; 5-8 puntos), la organización de la carga asistencial (6; 3-9 puntos), las dificultades en la coordinación con otros servicios clínicos o centrales (6; 5-7 puntos y 6; 5-8 puntos, respectivamente) Conclusiones. La investigación clínica es muy bien valorada por los internistas dedicados a la patología infecciosa. Las principales necesidades percibidas son un mayor apoyoinstitucional y de la dirección del hospital, una mejor organización del departamento, lacoordinación interdepartamental y disponer de más tiempo para esta actividad. Background. The involvement of attending physicians in clinical research activities differs greatly among institutions. Method. Cross-sectional study based on a survey submitted to the members of the Working Group on Infectious Diseases (GTei) of the Spanish Society of Internal Medicine (SEMI) during the month of May 2022. Results. Out of 1,789 members of the GTei, 169 members (9.45%) completed the survey. The perception of the convenience of participation of each physician in one or more lines of research was 8 points (P25:7; P75: 9 points). The perception of encouragement to do research by the health system or hospital management was 2 points (1-4), respectively. Support for research was rated at 5 (2-7) and 6 (3-7) points inrelation to the head of service and colleagues in the department, respectively. Other factors evaluated were the lack of time due to not being able to reduce the care activity (9; 7-10 points), prioritization of leisure activities during available free time (7; 5-8 points), organization of the care load (6; 3-9 points), difficulties in coordinating with other clinical or central services (6; 5-7 points and 6; 5-8 points, respectively). Conclusions. Clinical research is highly valued by internists dedicated to infectious diseases. The main perceived needs are greater institutional and hospital managementsupport, better organization of the department, interdepartmental coordination and more time for this activity.

Background: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. Method: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. Results: Three cases (20 %) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67 %) received treatment with proton pump inhibitors (PPIs) versus 2 (13 %) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14 %). Fourteen (93 %) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87 %), immunosuppressive treatment (7 patients, 47 %) and less patients had received previous antibiotic treatment (3 patients, 20 %) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66 % and 80 %, respectively p = 0.266). Conclusions: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.

Background: Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation. Methods: We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included. Results: During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients. Conclusions: One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients.