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In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. Mexico is no exception, and therefore the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, endoscopists, internists, infectious disease specialists, and microbiologists) to carry out the “Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection”, establishing useful recommendations (in relation to the adult population) for the medical community.Said recommendations are presented herein. Among them, it was recognized that CDI should be suspected in subjects with diarrhea that have a history of antibiotic and/or immunosuppressant use, but that it can also be a community-acquired infection. A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. Another recommendation was that CDI based on clinical evaluation be categorized as mild-moderate, severe, and complicated severe, given that such a classification enables better therapeutic decisions to be made. In mild-moderate CDI, oral vancomycin is the medication of choice, and metronidazole is recommended as an alternative treatment. In addition, fecal microbiota transplantation was recognized as an efficacious option in patients with recurrence or in the more severe cases of infection, and surgery should be reserved for patients with severe colitis (toxic megacolon), in whom all medical treatment has failed. Resumen: La infección por Clostridium difficile (ICD) en las últimas décadas se ha convertido en un problema de salud mundial. Nuestro país no es la excepción, y por ello la Asociación Mexicana de Gastroenterología reunió a un grupo multidisciplinario (gastroenterólogos, endoscopistas, internistas, infectólogos y microbiólogos), para que realizaran el «Consenso sobre prevención, diagnóstico y tratamiento de la infección por Clostridium difficile» y se establecieran recomendaciones (dirigidas a población adulta) de utilidad para la comunidad médica.Las recomendaciones emitidas se presentan en este documento. Se reconoce que la ICD debe sospecharse en sujetos con diarrea con antecedente de uso de antibióticos y/o inmunosupresión, pero que también puede adquirirse en la comunidad. Se propone seguir un algoritmo de dos pasos para el diagnóstico, utilizando una primera prueba de alta sensibilidad como la glutamato deshidrogenasa (GDH) y, en caso de resultado positivo, se debe confirmar mediante detección de toxinas por técnica de inmunoensayo o con pruebas de detección de ácidos nucleicos. Se recomienda categorizar la ICD con base en la evaluación clínica en leve-moderada, grave o grave complicada, ya que esto permite una mejor decisión terapéutica. En la ICD leve-moderada la vancomicina oral es el medicamento de elección, y se recomienda usar metronidazol como tratamiento alternativo. El trasplante de microbiota fecal se reconoce como una opción eficaz ante las recurrencias o los casos más graves, y la cirugía debe reservarse a pacientes con colitis grave (megacolon tóxico) que han fallado a todo tratamiento médico. Keywords: Clostridium difficile, Mexico, Diarrhea, In-hospital, Infection, Dysbiosis, Palabras clave: Clostridium difficile, México, Diarrea, Hospitalario, Infección, Disbiosis

Resumen: La infección por Clostridium difficile (ICD) en las últimas décadas se ha convertido en un problema de salud mundial. Nuestro país no es la excepción, y por ello la Asociación Mexicana de Gastroenterología reunió a un grupo multidisciplinario (gastroenterólogos, endoscopistas, internistas, infectólogos y microbiólogos), para que realizaran el «Consenso sobre prevención, diagnóstico y tratamiento de la infección por Clostridium difficile» y se establecieran recomendaciones (dirigidas a población adulta) de utilidad para la comunidad médica.Las recomendaciones emitidas se presentan en este documento. Se reconoce que la ICD debe sospecharse en sujetos con diarrea con antecedente de uso de antibióticos y/o inmunosupresión, pero que también puede adquirirse en la comunidad. Se propone seguir un algoritmo de dos pasos para el diagnóstico, utilizando una primera prueba de alta sensibilidad como la glutamato deshidrogenasa (GDH) y, en caso de resultado positivo, se debe confirmar mediante detección de toxinas por técnica de inmunoensayo o con pruebas de detección de ácidos nucleicos. Se recomienda categorizar la ICD con base en la evaluación clínica en leve-moderada, grave o grave complicada, ya que esto permite una mejor decisión terapéutica. En la ICD leve-moderada la vancomicina oral es el medicamento de elección, y se recomienda usar metronidazol como tratamiento alternativo. El trasplante de microbiota fecal se reconoce como una opción eficaz ante las recurrencias o los casos más graves, y la cirugía debe reservarse a pacientes con colitis grave (megacolon tóxico) que han fallado a todo tratamiento médico. Abstract: In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. Mexico is no exception, and therefore the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, endoscopists, internists, infectious disease specialists, and microbiologists) to carry out the “Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection”, establishing useful recommendations (in relation to the adult population) for the medical community.Said recommendations are presented herein. Among them, it was recognized that CDI should be suspected in subjects with diarrhea that have a history of antibiotic and/or immunosuppressant use, but that it can also be a community-acquired infection. A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. Another recommendation was that CDI based on clinical evaluation be categorized as mild-moderate, severe, and complicated severe, given that such a classification enables better therapeutic decisions to be made. In mild-moderate CDI, oral vancomycin is the medication of choice, and metronidazole is recommended as an alternative treatment. In addition, fecal microbiota transplantation was recognized as an efficacious option in patients with recurrence or in the more severe cases of infection, and surgery should be reserved for patients with severe colitis (toxic megacolon), in whom all medical treatment has failed. Palabras clave: Clostridium difficile, México, Diarrea, Hospitalario, Infección, Disbiosis, Keywords: Clostridium difficile, Mexico, Diarrhea, In-hospital, Infection, Dysbiosis

Introduction and Aim: Even if Sars-Cov 2 is an emergent, primarily respiratory illness, hepatic function alterations has been described by different countries. This work aims to describe the hepatic function alterations of patients with COVID-19 and their association with comorbilities and mortality. Material and Methods: We conducted an observational, retrospective, cross-sectional, descriptive study, using files from patients Sars-COv 2 positive PCR test admitted at Hospital 450 between March 13th through October 31st 2020, including that patients with liver function test. Sociodemographic data, symptoms, hospitalization area, outcome and laboratory results were registered. In addition, a descriptive analysis, X2 test and OR risk association were performed. Results: 466 patients were admitted at the hospital in this period of time, 69 patients without liver function test were excluded. A total of 397 patients were included: 60.2% were men, and 39.8% female. The mean age was 57 years old (16-95). 95.5% were communitary cases. Mean evolution days were 7.4 (1-37), and mean hospitalization days 8.6 (1-65). The symptoms related were: dyspnea (93.5%), cough (73%), fever (71%), myalgia (69.5%), headache (56.4%), odynophagia (27.7%), diarrhea(9.3%) and vomit (6%). Intubation were necessary in 27.2%, 28.8% had sepsis, and 15.1% were in shock status. The more frequent comorbidities were: hypertension (53%), DM (40.8%), obesity (43.1%), renal illness (14.1%) and other liver disease (3%). 33% of the patients were admitted to the intensive care unit. 63.7% demonstrated aminotransferase alterations (38% both AMT), most frequently AST (253 patients with twice normal values), hypoalbuminemia (64.7%), Alkaline Phosphatase (29.2%), and Total Bilirubin increased values (21.4%). In 61.2% of the patients anemia were detected, lymphopenia (55.4%), thrombocytopenia (17.9%), increased D dimer (79.8%), increased PCR (72.3 %). 41.1% of the patients died. Mortality association was found with: hypoalbuminemia (0.049) OR=1.548 IC95% (1.0-2.395); shock state (0.000) OR=13.995 IC95% (6.4-30.43); sepsis (0.000) OR=10.56 IC95% (6.2-17.72), intubation (0.000) OR=13.995 IC95% (12.5-45.0), renal illness (0.000) OR=5.45 IC95% (2.86-10.38), hypertension (0.000) OR=1.7 IC95% (1.13-2.55), and cardiovascular disease (0.01) OR=2.45 IC95% (1.21-4.95). No association between AMT and mortality was found. Discussion: An elevated percentage of AMT anomalies was found, as in other works, almost one third of the patients presented with elevated AP, instead of 1.8% reported in other studies. A bad prognosis was associated with hypoalbuminemia. Conclusions: Two thirds of the patients presented hypoalbuminemia and AMT increased, and in a few percentages with BT and AP anomalies. Hypoalbuminemia increases mortality risk.The authors declare that there is no conflict of interest.