Does the handling time of unrefrigerated human fecal specimens impact the detection of Clostridium difficile toxins in a hospital setting?

Rapid and accurate diagnosis of Clostridium difficile infection (CDI) is crucial for patient care, infection control, and efficient surveillance. We evaluated C. DIFF QUIK CHEK COMPLETE (QCC; TechLab), which detects glutamate dehydrogenase (GDH) antigen (QCC-Ag) and toxin A/B (QCC-Tox) simultaneously, and compared it to the laboratory diagnostics for CDI currently in use in a tertiary hospital setting with a high prevalence of CDI. QCC, RIDASCREEN C. difficile toxin A/B assay (Toxin EIA; R-Biopharm AG), chromID C. difficile agar (bioMérieux) culture (ChromID culture), and Xpert C. difficile PCR assay (Xpert PCR; Cepheid) were performed according to the manufacturers' instructions. Performances of the assays were compared against that of Xpert PCR as a reference. Of the 231 loose stool specimens, 83 (35.9%) were positive by Xpert PCR. The sensitivity, specificity, and positive and negative predictive values were 97.6%, 93.9%, 90.0%, and 98.6%, respectively, for QCC-Ag and 55.4%, 100%, 100%, and 80.0%, respectively, for QCC-Tox. The median threshold cycle values of the QCC-Tox(+) specimens were lower than those of the QCC-Tox(−) specimens. Results of QCC as an initial screening test were confirmed in 81.0% (187/231) of samples; these specimens did not require further testing. QCC is a rapid, easy, and cost-effective method that would be a useful first-line screening assay for laboratory diagnosis of CDI in a tertiary hospital with a high prevalence of CDI. A two-step algorithm using QCC as an initial screening tool, followed by Xpert PCR as a confirmatory test, is a practical and cost-effective approach.

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The Use of Probiotics in the Prevention of Clostridium Difficile Infection

10.28971/532016ml85 ◽

2016 ◽

Author(s):

Lindsay Mook

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Healthcare Providers ◽

Hospital Setting ◽

Retrospective Chart Review ◽

The United States ◽

Hospitalized Patients ◽

Study Results ◽

Prescribing Trends ◽

Hospital Acquired

<p>Despite advances in the diagnosis and treatment of Clostridium difficile infection (CDI), the prevention of CDI, particularly in the inpatient hospital setting, remains a challenge. Clostridium difficile now rivals methicillin-resistant staphylococcus aureus (MRSA) as the most common pathogen to cause hospital acquired infections (HAI) in the United States. Hospitalized patients are considered to be especially high risk for CDI, and among inpatient cases, antibiotic treatment, especially with Fluoroquinolones has been an almost universal factor in the development of CDIs. One preventative measure that is incontinently used in the prevention of CDI is oral probiotics. Probiotic consumption is reported to exert a myriad of beneficial effects including enhanced immune response, balancing of colonic microbiota, treatment of diarrhea associated with travel and antibiotic therapy, control of rotavirus and clostridium difficile induced colitis. The American College of Gastroenterology recognizes the role of probiotics and included probiotics as a level B recommendation for the treatment of CDI. It has been hypothesized that the use of probiotics, as an adjunctive therapy in patients receiving antibiotics, may provide a key intervention in reducing primary CDI. The purpose of this study was to conduct a retrospective chart review to explore healthcare providers prescribing trends regarding Fluoroquinolone antibiotics and adjunctive probiotics in patients with hospital acquired CDI. The Synergy model was used to guide the study. Results indicated that probiotics are not frequently prescribed for hospitalized patients on Fluoroquinolones and when they are it is with inconsistency. Additional research is recommended to further assess the use of probiotics in conjunction with other classes of commonly used antibiotics; this study solely looked at Fluoroquinolones.</p>

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Diabetes mellitus as a risk factor for recurrence of Clostridium difficile infection in the acute care hospital setting

American Journal of Infection Control ◽

10.1016/j.ajic.2010.08.017 ◽

2011 ◽

Vol 39 (3) ◽

pp. 194-198 ◽

Cited By ~ 37

Author(s):

Rada Shakov ◽

Raquel S. Salazar ◽

Silvester K. Kagunye ◽

Walid J. Baddoura ◽

Vincent A. DeBari

Keyword(s):

Diabetes Mellitus ◽

Risk Factor ◽

Clostridium Difficile ◽

Acute Care ◽

Clostridium Difficile Infection ◽

Hospital Setting ◽

Acute Care Hospital ◽

Care Hospital ◽

Risk Factor For Recurrence

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A narrative review of clinical management of Clostridium difficile in hospital setting

Journal of Clinical Medicine Bach Mai Hospital ◽

10.52322/jocmbmh.07.en.01 ◽

2021 ◽

Vol 07.en ◽

Keyword(s):

Clostridium Difficile ◽

Clinical Management ◽

Hospital Setting ◽

Narrative Review

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Impact of an automatic hospital probiotic protocol on Clostridioides (Clostridium) difficile infection (CDI) rates and CDI antibiotic usage in a community hospital setting

Journal of Infection Prevention ◽

10.1177/1757177419892309 ◽

2019 ◽

Vol 21 (2) ◽

pp. 72-75

Author(s):

Douglas Slain ◽

Amy Georgulis ◽

Ron Dermitt ◽

Laura Morris ◽

Stephen M Colodny

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Community Hospital ◽

Hospital Setting ◽

Saccharomyces Boulardii ◽

Antibiotic Usage ◽

Oral Vancomycin ◽

Hospitalised Patients ◽

Oral Metronidazole

The aim of the present study was to see how widespread preventative use of the probiotic Saccharomyces boulardii via automatic protocol in hospitalised patients receiving antibacterials affected rates of hospital-associated Clostridioides ( Clostridium) difficile infection (HA-CDI). Rates of HA-CDI appeared to be similar between the pre-protocol and protocol periods. Use of CDI treatment antibiotics (oral metronidazole and oral vancomycin) was also similar. Laboratory-confirmed isolation of S. boulardii from sterile body sites was identified in five patients during the protocol versus only one case in the pre-protocol years.

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Is there any value in measuring faecal calprotectin in Clostridium difficile positive faecal samples?

Journal of Medical Microbiology ◽

10.1099/jmm.0.067389-0 ◽

2014 ◽

Vol 63 (4) ◽

pp. 590-593 ◽

Cited By ~ 13

Author(s):

Simon J. Whitehead ◽

Kate E. Shipman ◽

Mike Cooper ◽

Clare Ford ◽

Rousseau Gama

Keyword(s):

Data Analysis ◽

Clostridium Difficile ◽

Intestinal Inflammation ◽

Hospital Setting ◽

Toxin Gene ◽

Faecal Calprotectin ◽

Faecal Samples ◽

Hospital Acquired ◽

Culture Negative ◽

Sensitive Marker

Markers of intestinal inflammation have been proposed for inclusion in Clostridium difficile diagnostic algorithms. Faecal calprotectin (f-Cp), a sensitive marker of intestinal inflammation, was evaluated for utility in C. difficile diagnosis in the hospital setting. One hundred and twenty C. difficile positive and 99 C. difficile negative faecal samples of hospital-acquired diarrhoea were analysed for f-Cp using a quantitative ELISA. C. difficile positivity was confirmed using ELISAs for either toxins (n = 45) or glutamate dehydrogenase (GDH) with toxin gene confirmation (n = 75). Non-parametric ANOVA (Kruskal–Wallis) was used for data analysis. C. difficile positive samples had higher (P<0.05) median (interquartile range) f-Cp levels; 336 µg g−1 (208–536) for toxin and 249 µg g−1 (155–498) for GDH and toxin gene positive compared with 106 µg g−1 (46–176) for C. difficile and culture-negative faecal samples. Five C. difficile positive samples were f-Cp negative (<50 µg g−1). A f-Cp concentration >50 µg g−1 was 96 % sensitive and 26 % specific for C. difficile, with area under the ROC curve of 0.82. There is no role for f-CP alone in predicting C. difficile infection in hospital-acquired diarrhoea due to its low specificity.

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