scholarly journals Mo1939 – Peripartum Clostridioides Difficile Infection and Its Effect on Pregnancy and Neonatal Outcomes: A Retrospective Cohort Study

2019 ◽  
Vol 156 (6) ◽  
pp. S-892-S-893
Author(s):  
Srishti Saha ◽  
Ryan M. Pardi ◽  
Darrell S. Pardi ◽  
Sahil Khanna
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Neonatal Outcomes ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals Use of Oral Vancomycin for Clostridioides difficile Infection and the Risk of Vancomycin-Resistant Enterococci

2019 ◽  
Vol 71 (3) ◽  
pp. 645-651 ◽  
Author(s):  
Vanessa W Stevens ◽  
Karim Khader ◽  
Kelly Echevarria ◽  
Richard E Nelson ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adjusted Relative Risk ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Vancomycin Resistant

Abstract Background Vancomycin is now a preferred treatment for all cases of Clostridioides difficile infection (CDI), regardless of disease severity. Concerns remain that a large-scale shift to oral vancomycin may increase selection pressure for vancomycin-resistant Enterococci (VRE). We evaluated the risk of VRE following oral vancomycin or metronidazole treatment among patients with CDI. Methods We conducted a retrospective cohort study of patients with CDI in the US Department of Veterans Affairs health system between 1 January 2006 and 31 December 2016. Patients were included if they were treated with metronidazole or oral vancomycin and had no history of VRE in the previous year. Missing data were handled by multiple imputation of 50 datasets. Patients treated with oral vancomycin were compared to those treated with metronidazole after balancing on patient characteristics using propensity score matching in each imputed dataset. Patients were followed for VRE isolated from a clinical culture within 3 months. Results Patients treated with oral vancomycin were no more likely to develop VRE within 3 months than metronidazole-treated patients (adjusted relative risk, 0.96; 95% confidence interval [CI], .77 to 1.20), equating to an absolute risk difference of −0.11% (95% CI, −.68% to .47%). Similar results were observed at 6 months. Conclusions Our results suggest that oral vancomycin and metronidazole are equally likely to impact patients’ risk of VRE. In the setting of stable CDI incidence, replacement of metronidazole with oral vancomycin is unlikely to be a significant driver of increased risk of VRE at the patient level. In this multicenter, retrospective cohort study of patients with Clostridioides difficile infection, the use of oral vancomycin did not increase the risk of vancomycin-resistant Enterococci infection at 3 or 6 months compared to metronidazole.

scholarly journals 707. Hospital-Onset Clostridioides difficile Infection Rates During COVID-19 Pandemic in the ICU Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S453-S453
Author(s):  
Evdokia Gavrielatou ◽  
prodromos Temperikidis ◽  
Michalis Tsimaras ◽  
eleni magira
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Setting ◽  
Contributing Factors ◽  
Protective Measures ◽  
Clostridioides Difficile ◽  
Positive Rate ◽  
Clostridioides Difficile Infection

Abstract Background Due to COVID-19 gastrointestinal microbiome alterations, COVID-19 can be complicated by Clostridioides difficile infection (CDI). This retrospective cohort study aimed to evaluate the prevalence of Clostridium difficile infection in patients with COVID-19pneumonia Methods A retrospective cohort study was conducted on PCR Covid-19 positive patients admitted in the ICU from September,2020 to 30th April 2021. All patients in the cohort study were on mechanical ventilation, or at some point during their ICU admission required mechanical ventilation. Hospital-onset (HO-CDI), defined as a positive C. difficile test over 3 days after admission. Results Overall, during the study period, a total of 240 PCR Covid-19 patients were admitted to the ICU; of these, 11 (4.5%) were COVID-19 CDI positive. Nine were males (81%). The mean hospital stay for these COVID-19 patients was 12 days (range 1–59 days). HO-CDI median day of identification was 12 days. All patients received ≥2 antibiotics and dexamethasone at admission. Compared to historical controls, COVID-19 patients did not have a higher overall CDI positive rate. However, mortality among COVID-19 HO-CDI patients was increased 7/11 (63%). Conclusion Whether COVID-19 itself increases an individual’s risk for CDI remains unclear. Multiple contributing factors drive CDI incidence, severity, and recurrence. Although protective measures such as gowns and gloves during COVID-19 increased, CDI cases in the hospital setting should continue to emphasize the importance of antimicrobial stewardship. Disclosures All Authors: No reported disclosures

scholarly journals Incidence of Clostridioides difficile infection in peripartum women: a retrospective cohort study

2020 ◽  
Vol 13 ◽  
pp. 175628482094262
Author(s):  
Srishti Saha ◽  
Ryan Pardi ◽  
Regan N. Theiler ◽  
Darrell S. Pardi ◽  
Sahil Khanna
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Time Trends ◽  
Retrospective Cohort ◽  
Population Data ◽  
Watery Diarrhea ◽  
Clostridioides Difficile ◽  
Positive Stool ◽  
Before And After ◽  
Clostridioides Difficile Infection

Background: The incidence of Clostridioides difficile infection (CDI) is increasing in the general population. Data on the epidemiology of CDI in peripartum women – a highly vulnerable patient population – is scarce. The objective of this study was to report the incidence of CDI in peripartum women. Methods: A single-center retrospective cohort study was conducted in peripartum women from 1997 to 2017. Peripartum CDI was defined as definite CDI (watery diarrhea for >24 h with positive stool assay) during pregnancy, or within 6 weeks postpartum. Incidence was reported per 100,000 pregnancies and time trends in incidence were analyzed using Poisson regression. Analyses were done separately for time trends before and after 2007, when CDI testing strategy changed to polymerase chain reaction. Results: From 1997 to 2017, 80 patients with peripartum CDI (47 during pregnancy, 33 postpartum) out of 125,683 pregnancies (0.064%) were identified. Incidence of CDI increased 3.4 fold (95% confidence interval 1.5–7.4, p = 0.005) over the 21 year period. Time trends were evident after ( p = 0.054), but not before 2007 ( p = 0.97). Conclusion: Incidence of CDI in peripartum women increased over the 21 year study period. The rise in incidence is concerning, and calls for heightened surveillance for CDI in this highly vulnerable population.

Predictors of Clostridioides difficile Infection Among Asymptomatic, Colonized Patients: A Retrospective Cohort Study

2019 ◽  
Vol 70 (10) ◽  
pp. 2103-2210 ◽  
Author(s):  
Dominic Poirier ◽  
Philippe Gervais ◽  
Margit Fuchs ◽  
Jean-Francois Roussy ◽  
Bianka Paquet-Bolduc ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Disease Onset ◽  
Primary Prophylaxis ◽  
Attributable Mortality ◽  
Clostridioides Difficile ◽  
Asymptomatic Patients ◽  
Clostridioides Difficile Infection ◽  
Potential Benefits

Abstract Background Asymptomatic patients colonized with Clostridioides difficile are at risk of developing C. difficile infection (CDI), but the factors associated with disease onset are poorly understood. Our aims were to identify predictors of hospital-onset CDI (HO-CDI) among colonized patients and to explore the potential benefits of primary prophylaxis to prevent CDI. Methods We conducted a retrospective cohort study in a tertiary academic institution. Colonized patients were identified by detecting the tcdB gene by polymerase chain reaction on a rectal swab. Univariate and multivariate logistic regression analyses were used to identify predictors of HO-CDI. Results There were 19 112 patients screened, from which 960 (5%) colonized patients were identified: 513 met the inclusion criteria. Overall, 39 (7.6%) developed a HO-CDI, with a 30-day attributable mortality of 15%. An increasing length of stay (adjusted odds ratio [aOR] per day, 1.03; P = .006), exposure to multiple classes of antibiotics (aOR per class, 1.45; P = .02), use of opioids (aOR, 2.78; P = .007), and cirrhosis (aOR 5.49; P = .008) were independently associated with increased risks of HO-CDI, whereas the use of laxatives was associated with a lower risk of CDI (aOR 0.36; P = .01). Among the antimicrobials, B-lactam with B-lactamase inhibitors (OR 3.65; P < .001), first-generation cephalosporins (OR 2.38; P = .03), and carbapenems (OR 2.44; P = .03) correlated with the greatest risk of HO-CDI. By contrast, patient age, the use of proton pump inhibitors, and the use of primary prophylaxis were not significant predictors of HO-CDI. Conclusions This study identifies several factors that are associated with CDI among colonized patients. Whether modifying these variables could decrease the risk of CDI should be investigated.

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