Molecular epidemiology of toxigenic Clostridioides difficile isolates from hospitalized patients and the hospital environment in Dhaka, Bangladesh

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient’s health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital’s technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient’s stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.

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Molecular epidemiology and antimicrobial resistance of Clostridioides difficile in Germany, 2014–2019

International Journal of Medical Microbiology ◽

10.1016/j.ijmm.2021.151507 ◽

2021 ◽

Vol 311 (4) ◽

pp. 151507

Author(s):

Ahmed Mohamed Mostafa Abdrabou ◽

Zia Ul Habib Bajwa ◽

Alexander Halfmann ◽

Alexander Mellmann ◽

Anna Nimmesgern ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Molecular Epidemiology ◽

Clostridioides Difficile

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Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa537 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Lindsay A Petty ◽

Valerie M Vaughn ◽

Scott A Flanders ◽

Twisha Patel ◽

Anurag N Malani ◽

...

Keyword(s):

Emergency Department ◽

Antibiotic Treatment ◽

Asymptomatic Bacteriuria ◽

Antibiotic Use ◽

Altered Mental Status ◽

Estimating Equation ◽

Hospitalized Patients ◽

Clostridioides Difficile ◽

Cord Injury ◽

Clostridioides Difficile Infection

Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. Methods We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018–February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Results Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08–1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P = .02). Conclusions Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.

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Prevalence of Staphylococcus aureus and Methicillin-resistant S. aureus in Adult Hospitalized Patients in “Mother Theresa” Hospital Center in Albania

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3565 ◽

2020 ◽

Vol 8 (A) ◽

pp. 297-302

Author(s):

Blerta Kika ◽

Erjona Abazaj ◽

Oltiana Petri ◽

Andi Koraqi

Keyword(s):

Staphylococcus Aureus ◽

Rapid Detection ◽

Latex Agglutination ◽

Hospitalized Patients ◽

Hospital Environment ◽

Drug Resistant ◽

Methicillin Resistant ◽

Clinical Specimens ◽

Microbial Identification ◽

Hospital Center

AIM: The aim of this study was to evaluate the prevalence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in clinical specimens hospitalized to “Mother Theresa” Hospital Center for 2 years. METHODS: We isolated and identified S. aureus on 356 clinical specimens using standard tests. Furthermore, for further accurate microbial identification, we have to use the VITEK® 2 system. The samples were tested to detect the presence of MRSA by a slide latex agglutination kit for the rapid detection of PBP2. RESULTS: The overall prevalence of S. aureus in patients was 34.2%. The prevalence of MRSA was 20.5% of cases. Of the MRSA isolates identified in this study, 28% were susceptible to antibiotics, 24% demonstrated intermediate resistance, and 48% were multi-drug resistant with resistance to nineteen antibiotics involved in the examination. In addition, seven of the 25 MRSA cases showed 100% resistance to norfloxacin, imipenem, meropenem, levofloxacin, etc. CONCLUSIONS: The rate of S. aureus in hospitalized patients on this study was 34.2% and the MRSA 20.5%. These results indicated that this type of infection is a significant concern for health services and patients included. A screening of all hospitalized cases can lead to reduce the incidence of this infection in the hospital environment.

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An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia

10.1101/2021.02.23.21252226 ◽

2021 ◽

Author(s):

Christopher A. Okeahialam ◽

Ali A. Rabaan ◽

Albert Bolhuis

Keyword(s):

Patient Outcome ◽

Saudi Arabia ◽

Antimicrobial Stewardship ◽

Laboratory Data ◽

Hospitalized Patients ◽

Antimicrobial Stewardship Program ◽

Repeated Testing ◽

Clostridioides Difficile ◽

Stewardship Program ◽

The Impact

AbstractBackgroundAntimicrobial stewardship has been associated with a reduction in the incidence of health care associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognized in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalized patients may offer an alternative metric for these settings, but its utlity remains largely untested.Aim/ObjectiveTo examine the impact of an antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalized patients presenting with diarrhoeaMethodsA 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programResultThere was a significant decline in the rate of toxigenic C difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship program, and a reversal of a rising trend.DiscussionThe rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is however dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.

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Molecular epidemiology of endemic Clostridioides difficile infection in Japan

Anaerobe ◽

10.1016/j.anaerobe.2021.102510 ◽

2022 ◽

pp. 102510

Author(s):

Mitsutoshi Senoh ◽

Haru Kato

Keyword(s):

Molecular Epidemiology ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

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Molecular epidemiology of Clostridioides difficile in domestic dogs and zoo animals

Anaerobe ◽

10.1016/j.anaerobe.2019.06.005 ◽

2019 ◽

Vol 59 ◽

pp. 107-111

Author(s):

M. Jahangir Alam ◽

Jacob McPherson ◽

Julie Miranda ◽

Allyson Thrall ◽

Van Ngo ◽

...

Keyword(s):

Molecular Epidemiology ◽

Domestic Dogs ◽

Clostridioides Difficile ◽

Zoo Animals

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Risk Factors Associated with Carbapenemase-Producing Enterobacterales (CPE) Positivity in the Hospital Wastewater Environment

Applied and Environmental Microbiology ◽

10.1128/aem.01715-20 ◽

2020 ◽

Vol 86 (24) ◽

Author(s):

Stacy C. Park ◽

Hardik Parikh ◽

Kasi Vegesana ◽

Nicole Stoesser ◽

Katie E. Barry ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Hospital Environment ◽

Hospital Wastewater ◽

Content Type ◽

The Past ◽

Clostridioides Difficile ◽

Increased Risk ◽

Increase Risk ◽

Gram Negative Organisms

ABSTRACT Hospital wastewater is an increasingly recognized reservoir for resistant Gram-negative organisms. Factors involved in establishment and persistence of Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) in hospital wastewater plumbing are unclear. This study was conducted at a hospital with endemic KPCOs linked to wastewater reservoirs and robust patient perirectal screening for silent KPCO carriage. Over 5 months, both rooms occupied and rooms not occupied by KPCO-positive patients were sampled at three wastewater sites within each room (sink drain, sink P-trap, and toilet or hopper). Risk factors for KPCO positivity were assessed using logistic regression. Whole-genome sequencing (WGS) identified environmental seeding by KPCO-positive patients. A total of 219/475 (46%) room sampling events were KPCO positive in at least one wastewater site. KPCO-positive patient exposure was associated with increased risk of environmental positivity for the room and toilet/hopper. Previous positivity and intensive care unit room type were consistently associated with increased risk. Tube feeds were associated with increased risk for the drain, while exposure to patients with Clostridioides difficile was associated with decreased risk. Urinary catheter exposure was associated with increased risk of P-trap positivity. P-trap heaters reduced risk of P-trap and sink drain positivity. WGS identified genomically linked environmental seeding in 6 of 99 room occupations by 40 KPCO-positive patients. In conclusion, KPCO-positive patients seed the environment in at least 6% of opportunities; once positive for KPCOs, wastewater sites are at greater risk of being positive subsequently. Increased nutrient exposure, e.g., due to tube food disposal down sinks, may increase risk; frequent flushing may be protective. IMPORTANCE Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) are bacteria that are resistant to most antibiotics and thus are challenging to treat when they cause infections in patients. These organisms can be acquired by patients who are hospitalized for other reasons, complicating their hospital stay and even leading to death. Hospital wastewater sites, such as sink drains and toilets, have played a role in many reported outbreaks over the past decade. The significance of our research is in identifying risk factors for environmental positivity for KPCOs, which will facilitate further work to prevent transmission of these organisms to patients from the hospital environment.

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Burden and risk factors for inappropriate Clostridioides Difficile infection testing among hospitalized patients

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2020.115283 ◽

2021 ◽

Vol 99 (4) ◽

pp. 115283

Author(s):

Ellen Axenfeld ◽

William G. Greendyke ◽

Jianhua Li ◽

Daniel A. Green ◽

Susan Whittier ◽

...

Keyword(s):

Risk Factors ◽

Hospitalized Patients ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection

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Norovirus Is the Most Frequent Cause of Diarrhea in Hospitalized Patients in Monterrey, Mexico

Pathogens ◽

10.3390/pathogens9090672 ◽

2020 ◽

Vol 9 (9) ◽

pp. 672

Author(s):

Néstor Casillas-Vega ◽

Fernanda Flores-Rodríguez ◽

Israel Sotelo-Coronado ◽

Magda Elizabeth Vera-García ◽

Aldo García-Heredia ◽

...

Keyword(s):

Entamoeba Histolytica ◽

Microscopic Observation ◽

Hospitalized Patients ◽

Salmonella Spp ◽

Fecal Samples ◽

Clostridioides Difficile ◽

Shigella Spp ◽

Level Hospital ◽

Clinical Problems ◽

Campylobacter Spp

Little information is available regarding the pathogens that cause diarrhea in hospitalized patients who also have various clinical problems. The purpose of this study was to determine the presence of pathogens in fecal samples of hospitalized patients all suffering diarrhea in addition to other problems in Mexico. Diarrheic stools from 240 patients were obtained in a third-level hospital in Monterrey, Mexico. PCR was used for the detection of Salmonella spp., Shigella spp., Campylobacter spp., Yersinia spp., Aeromonas spp., Clostridioides difficile, and norovirus GI and GII. The presence of trophozoites, cysts of protozoa, eggs, and/or helminth larvae was determined by microscopic observation. Of the 240 patients analyzed, 40.4% presented at least one of the pathogens analyzed. Norovirus was the pathogen most frequently found (28.6%), followed by bacteria (11.7%), and parasites (8.3%). The majority of co-infections were parasites + norovirus, and bacteria + norovirus. Norovirus was detected mainly in children aged 0 to 10 years (9/15, 60%). Patients aged 0–20 years did not present co-infections. Entamoeba coli and Entamoeba histolytica were the most common parasites, (8/240), and Salmonella was the most prevalent bacteria (10/240). This information can help design specific strategies useful for hospitalized people with a compromised status.

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