Hospital acquired Clostridioides difficile infection and risk factors for severity in a university hospital: A prospective study

Data on the burden of Clostridioides difficile infection (CDI) in Coronavirus Disease 2019 (COVID-19) patients are scant. We conducted an observational, retrospective, multicenter, 1:3 case (COVID-19 patients with CDI)-control (COVID-19 patients without CDI) study in Italy to assess incidence and outcomes, and to identify risk factors for CDI in COVID-19 patients. From February through July 2020, 8402 COVID-19 patients were admitted to eight Italian hospitals; 38 CDI cases were identified, including 32 hospital-onset-CDI (HO-CDI) and 6 community-onset, healthcare-associated-CDI (CO-HCA-CDI). HO-CDI incidence was 4.4 × 10,000 patient-days. The percentage of cases recovering without complications at discharge (i.e., pressure ulcers, chronic heart decompensation) was lower than among controls (p = 0.01); in-hospital stays was longer among cases, 35.0 versus 19.4 days (p = 0.0007). The presence of a previous hospitalisation (p = 0.001), previous steroid administration (p = 0.008) and the administration of antibiotics during the stay (p = 0.004) were risk factors associated with CDI. In conclusions, CDI complicates COVID-19, mainly in patients with co-morbidities and previous healthcare exposures. Its association with antibiotic usage and hospital acquired bacterial infections should lead to strengthen antimicrobial stewardship programmes and infection prevention and control activities.

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Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.206 ◽

2020 ◽

Vol 41 (9) ◽

pp. 1048-1057 ◽

Cited By ~ 1

Author(s):

Jiyoun Song ◽

Bevin Cohen ◽

Philip Zachariah ◽

Jianfang Liu ◽

Elaine L. Larson

Keyword(s):

Risk Factors ◽

New York ◽

Kendall Test ◽

Incidence Density ◽

Care Community ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Ongoing Surveillance ◽

Hospital Acquired ◽

Over Time

AbstractObjective:Given recent changes in the epidemiology of Clostridioides difficile infection (CDI) and prevention efforts, we investigated temporal changes over a period of 11 years (2006–2016) in incidence and risk factors for CDI.Design:Retrospective matched case-control study.Setting/Patients:Pediatric and adult inpatients (n = 694,849) discharged from 3 hospitals (tertiary and quaternary care, community, and pediatric) in a large, academic health center in New York City.Methods:Risk factors were identified in cases and controls matched by length of stay at a ratio of 1:4. A Cochran–Armitage or Mann-Kendall test was used to investigate trends of incidence and risk factors.Results:Of 694,849 inpatients, 6,038 (0.87%) had CDI: 44% of these cases were hospital acquired (HA-CDI) and 56% were community acquired (CA-CDI). We observed temporal downward trends in HA-CDI (−0.03% per year) and upward trends in CA-CDI (+0.04% per year). Over time, antibiotics were administered to more patients (+3% per year); the use of high-risk antibiotics declined (–1.2% per year); and antibiotic duration increased in patients with HA-CDI (+4.4% per year). Fewer proton-pump inhibitors and more histamine-2 blockers were used (−3.8% and +7.3% per year, respectively; all Ptrend <.05).Conclusions:Although the incidence of HA-CDI decreased over time, CA-CDI simultaneously increased. Continued efforts to assure judicious use of antibiotics in inpatient and community settings is clearly vital. Measuring the actual the level of exposure of an antibiotic (incidence density) should be used for ongoing surveillance and assessment.

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Extended-Spectrum Beta-Lactamase Producing Bacteria: Epidemiology, Risk Factors, Diagnostic Methodology, and Antimicrobial Susceptibility Profile: A Prospective Study at a University Hospital in Western Saudi Arabia

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2019.9.2.2 ◽

2019 ◽

Vol 9 (2) ◽

pp. 5-18

Author(s):

Dalal Mohammad Alashari ◽

Maha Mahmoud Al-Alawi ◽

Asif Ahmad Jiman-Fatani

Keyword(s):

Risk Factors ◽

Multidrug Resistance ◽

Prospective Study ◽

Antimicrobial Susceptibility ◽

University Hospital ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Vitek 2 ◽

A Prospective Study

Objective: To study the prevalence and incidence of extended-spectrum beta-lactamase -producing microorganisms, microbiological characteristics and antimicrobial-susceptibility patterns. Methods: A prospective study involving all cases of extended-spectrum beta-lactamase -producing microorganisms among all bacteriological samples collected over a 1-year period from 11 November 2015 to 10 November 2016, in the Clinical and Molecular Microbiology Laboratory at King Abdulaziz University Hospital, Jeddah. Detection of extended-spectrum beta-lactamase-producing microorganisms and antimicrobial-susceptibility profiles were done using automated Vitek 2 system. Clinical data such as recent use of antibiotics or invasive devices were investigated as risk factors for multidrug resistance. Results: The prevalence of extended-spectrum beta-lactamase-producing microorganisms was 5.4% (95% CI = 4.7% – 6.2%); for an incidence = 54 per 1,000 isolates-years. Distribution by species showed 70.0% Escherichia coli, 28.5% Klebsiella pneumoniae and 1.5% Proteus mirabilis. Vitek 2 system showed 6% of false positive ESBL detections by reference to confirmatory E-test. Antimicrobial- susceptibility tests showed that 86.5% of beta-lactamase-producing strains were resistant to ≥ 1 other antimicrobial class and 20% were multidrug resistant. Univariate logistic regression showed that the presence of multidrug resistance was significantly predicted by age (OR = 1.02; P = 0.026), use of urinary catheter (OR = 2.05; P = 0.046) and number of devices used (OR = 1.60; P = 0.046); only age (OR = 1.02; P = 0.022) was significant in the multivariate model. Conclusion: Clinicians and microbiologists should maintain a high level of alertness and contribute for effective screening and adequate treatment of infections caused by beta-lactamase-producing organisms according to international guidelines and the local epidemiological picture.

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