scholarly journals Gut microbiota composition in health-care facility-and community-onset diarrheic patients with Clostridioides difficile infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giovanny Herrera ◽  
Laura Vega ◽  
Manuel Alfonso Patarroyo ◽  
Juan David Ramírez ◽  
Marina Muñoz
Keyword(s):  
Health Care ◽  
Gut Microbiota ◽  
Care Facility ◽  
Health Care Facility ◽  
Influential Factors ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
The Impact ◽  
Positive Groups ◽  
Community Onset

AbstractThe role of gut microbiota in the establishment and development of Clostridioides difficile infection (CDI) has been widely discussed. Studies showed the impact of CDI on bacterial communities and the importance of some genera and species in recovering from and preventing infection. However, most studies have overlooked important components of the intestinal ecosystem, such as eukaryotes and archaea. We investigated the bacterial, archaea, and eukaryotic intestinal microbiota of patients with health-care-facility- or community-onset (HCFO and CO, respectively) diarrhea who were positive or negative for CDI. The CDI-positive groups (CO/+, HCFO/+) showed an increase in microorganisms belonging to Bacteroidetes, Firmicutes, Proteobacteria, Ascomycota, and Opalinata compared with the CDI-negative groups (CO/−, HCFO/−). Patients with intrahospital-acquired diarrhea (HCFO/+, HCFO/−) showed a marked decrease in bacteria beneficial to the intestine, and there was evidence of increased Archaea and Candida and Malassezia species compared with the CO groups (CO/+, CO/−). Characteristic microbiota biomarkers were established for each group. Finally, correlations between bacteria and eukaryotes indicated interactions among the different kingdoms making up the intestinal ecosystem. We showed the impact of CDI on microbiota and how it varies with where the infection is acquired, being intrahospital-acquired diarrhea one of the most influential factors in the modulation of bacterial, archaea, and eukaryotic populations. We also highlight interactions between the different kingdoms of the intestinal ecosystem, which need to be evaluated to improve our understanding of CDI pathophysiology.

scholarly journals Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Brandon J. Webb ◽  
Aruna Subramanian ◽  
Bert Lopansri ◽  
Bruce Goodman ◽  
Peter Bjorn Jones ◽  
...  
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Content Type ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Intermountain Healthcare ◽  
Health Care Associated Infection

ABSTRACT Clostridioides difficile infection (CDI) is a health care-associated infection associated with significant morbidity and cost, with highly varied risk across populations. More effective, risk-based prevention strategies are needed. Here, we investigate risk factors for hospital-associated CDI in a large integrated health system. In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (i) hospital-onset and (ii) health care-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including that of specific agents, using multivariable logistic regression. A total of 2,356 cases of CDI among 506,068 admissions were identified (incidence, 46.6 per 10,000). Prior antibiotic use was the dominant risk factor, where for every antibiotic day of therapy prior to the index admission, the odds of subsequent CDI increased by 12.8% (95% confidence interval [CI], 12.2 to 13.4%; P < 0.0001). This was a much stronger association than was inpatient antibiotic exposure (odds ratio [OR], 1.007 [95% CI, 1.005 to 1.009]; P < 0.0001). The highest-risk antibiotics included second-generation and later cephalosporins (especially oral), carbapenems, fluoroquinolones, and clindamycin, while doxycycline and daptomycin were associated with a lower CDI risk. We concluded that cumulative antibiotic exposure prior to admission is the greatest contributor to the risk of subsequent CDI. Most classes of antibiotics carry some risk, which varies by drug and route. This information may be useful for antimicrobial stewardship efforts.

scholarly journals Pet Ownership Protects Against Recurrence of Clostridioides difficile Infection

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Laurel E Redding ◽  
Brendan J Kelly ◽  
Darko Stefanovski ◽  
John K Lautenbach ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Costs ◽  
Care Facility ◽  
Health Care Facility ◽  
Food Allergies ◽  
Pet Ownership ◽  
Clostridioides Difficile ◽  
Point Increase ◽  
Clostridioides Difficile Infection ◽  
Control Study

Abstract Background Clostridioides difficile infection (CDI) is the leading cause of antibiotic-associated and health care–associated diarrhea in humans. Recurrent CDI (R-CDI) occurs in ~20%–30% of patients with CDI and results in increased morbidity, mortality, and hospital costs. Genomic analyses have shown overlap of C. difficile isolates from animals and people, suggesting that a zoonotic reservoir may contribute to recurrence. The objective of this study was to determine whether pet ownership is a risk factor for recurrence of CDI. Methods We conducted a case–control study among patients with recurrent CDI (cases; n = 86) and patients with nonrecurrent CDI (controls; n = 146). Multivariable logistic regression modeling was used to determine the association between recurrence of CDI and pet ownership while accounting for patient-level risk factors. Results Pet ownership was not significantly associated with recurrence of CDI (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.38–2.72; P = 0.965) among all patients (n = 232). However, among the subset of patients with community-associated or community-onset health care facility–acquired CDI (n = 127), increasing contact with pets was increasingly protective against recurrence: for every point increase in a pet contact score (out of 7 possible points), the odds of recurrence decreased by 14% (OR, 0.86; 95% CI, 0.74–1.00; P = 0.051). Conclusions Close interactions with pets appear protective against the recurrence of community-acquired CDI. A potential mechanism may involve beneficial contributions to the microbiota of pet owners afflicted with CDI, as has been observed for other conditions such as atopy, obesity, and food allergies. However, more research is needed to understand the interactions between pets, owners, and their microbiota.

scholarly journals The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania.

2020 ◽  
Author(s):  
Corinna Vossius ◽  
Estomih Md ◽  
Robert Moshiro ◽  
Paschal M ◽  
Jan Terje Kvaløy ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Low Birthweight ◽  
Care Facility ◽  
Health Care Facility ◽  
Skilled Birth Attendance ◽  
Health Care Facilities ◽  
Birth Attendance ◽  
Vaginal Deliveries ◽  
The Impact

Abstract Background: Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees . Methods: Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes. Results: A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently, while labour complication and caesarean sections were more frequent. There was a reduction of newborns with birth weight less than 2500 grams. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks. Conclusion: After the introduction of ambulance and delivery fees an increase in labour complications and caesarean sections of about 80 per 1000 births and a decrease in non-cephalic presentations and newborns with low birthweight of about 17 per 1000 births each was observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.

scholarly journals Nursing dress code and perception of a nurse by patients

2019 ◽  
Vol 18 (1) ◽  
pp. 60-67
Author(s):  
Piotr Pawłowski ◽  
Paulina Mazurek ◽  
Magdalena Zych ◽  
Katarzyna Zuń ◽  
Beata Dobrowolska
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Dress Code ◽  
Medical Interventions ◽  
Online Databases ◽  
Administrative Employees ◽  
Strategy Planning ◽  
Professional Image ◽  
The Impact

AbstractIntroduction. Professional image of the nurse in the opinion of the patient community is conditioned by many variables, including professional attire. A worthy representation of the nurse profession is the responsibility of all those who care for the patient.Aim. Determining the impact of dress code on shaping the professional image of nurses in the opinion of patients.Material and methods. Non-systematic review method of the literature available. The data was obtained by searching online databases, such as: Google Scholar, PubMed, CINAHL Complete as well as electronic resources of nursing magazines.Results. In the perception of hospitalized patients, the nursing dress code affects the level of trust in those who care for patients, it also constitutes an important element in assessing their professionalism, knowledge or confidence when performing specific medical interventions. Adapted to the needs, a suitably selected style of professional attire of a nurse employed in a given health care facility enables her proper identification of them against the background of other members of the therapeutic team or administrative employees. In addition, the comfort of nurses is a significant factor for patients in dress code strategy planning; it often determines professionalism and quality of services provided.Conclusions. There is a relationship between the external appearance of nurses and their professional image and the patients’ perception of their professional skills as well as the level of their professionalism. Dress code in a health care facility may constitute a significant element of image policy for both a health care facility itself and a group of nurses.

scholarly journals The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania.

2020 ◽  
Author(s):  
Corinna Vossius ◽  
Hege Ersdal ◽  
Jan Terje Kvaløy ◽  
Paschal M ◽  
Estomih Md ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Low Birthweight ◽  
Care Facility ◽  
Health Care Facility ◽  
Skilled Birth Attendance ◽  
Health Care Facilities ◽  
Birth Attendance ◽  
Vaginal Deliveries ◽  
The Impact

Abstract Background: Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees . Methods: Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes. Results: A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently, while labour complication and caesarean sections were more frequent. There was a reduction of newborns with birth weight less than 2500 grams and an increase in newborns weighing more than 4000 grams. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks. Conclusion: After the introduction of ambulance and delivery fees an increase in labour complications and caesarean sections of about 80 per 1000 births and a decrease in non-cephalic presentations and newborns with low birthweight of about 17 per 1000 births each was observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.

scholarly journals The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

2020 ◽  
Author(s):  
Corinna Vossius ◽  
Estomih Md ◽  
Robert Moshiro ◽  
Paschal M ◽  
Jan Terje Kvaløy ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Low Birthweight ◽  
Care Facility ◽  
Health Care Facility ◽  
Skilled Birth Attendance ◽  
Health Care Facilities ◽  
Birth Attendance ◽  
Vaginal Deliveries ◽  
The Impact

Abstract Background:Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees.Methods:Retrospective analysis of data from a prospective observational study. Data was compared between the period before introduction of fees from February 2010 through June 2013 and the period after from January 2014 through January 2017. Logistic regression modelling was used to construct risk-adjusted variable-life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes.Results:A total of 28,601 births were observed. The monthly number of births was reduced by 17.3% during the post-introduction period. Spontaneous vaginal deliveries were registered less frequently with a decrease of about 17/1000 births in non-cephalic presentations. Labour complications and caesarean sections increased with about 80/1000 births. There was a reduction in newborns with birth weight less than 2500 grams. The observed changes were stable over time. For most variables, a significant change could be detected after a few weeks.Conclusion:After the introduction of ambulance and delivery fees, an increase in labour complications and caesarean sections and newborns with low birthweight were observed. This might indicate that women delay the decision to seek skilled birth attendance or do not seek help at all, possibly due to financial reasons. Lower rates of births in a safe health care facility like HLH is of great concern, as access to skilled birth attendance is a key requirement in order to further reduce perinatal mortality. Therefore, free delivery care should be a high priority.

Trends in the incidence and outcomes of Clostridioides difficile infection in hematological cancers: A nationwide analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18244-e18244
Author(s):  
Fateeha Furqan ◽  
Raseen Tariq ◽  
Nicolas Goldstein ◽  
Sanjana Kashinath ◽  
Saad Jamshed ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Hematologic Malignancy ◽  
Care Facility ◽  
Healthcare Facility ◽  
National Hospital Discharge Survey ◽  
Clostridioides Difficile ◽  
Hematologic Cancer ◽  
Hematological Cancers ◽  
Clostridioides Difficile Infection ◽  
The Impact

e18244 Background: Clostridioides difficile infection (CDI) has higher incidence in cancer patients. To characterize the extent of CDI burden among hematologic cancer patients, we used the National Hospital Discharge Survey (NHDS) to report the incidence and outcomes of CDI. Methods: NHDS data from 2001-2010 were analyzed using diagnosis codes to identify patients with hematologic cancers and CDI. Demographics and discharge information were compared amongst hematologic cancer patients with and without CDI. Logistic regression models were runto estimate the impact of CDI on hematologic cancer patient outcomes, using STATA 12.0. Results: During the years 2001-2010, about 3.7 million patients (weighted data) were discharged with hematologic cancer. Among them, the incidence of CDI was 2.3%. Hematologic cancer patients with CDI were younger (mean age 66 vs 68 years), more likely to be men (66% vs 64.5%), to be of white race (68.1% vs 67.7%) and to have emergent admissions (73% vs 69%), all p values < 0.001. CDI incidence in these patients showed a steeper increase than non-cancer patients, with highest incidence in 2008-2009. Hematologic cancer patients with CDI had a longer mean Length of stay (16.9 vs 7.1 days; adjusted odds ratio (aOR) 9.5, 95% CI 9.4-9.6), all cause hospital mortality (11.3% vs 6.3%; aOR 1.92, 95% CI 1.88-1.97) and discharge to a care facility (28.4% vs 18.8%; aOR 2.06, 95% CI 2.02-2.10) compared to non-CDI cancer patients. Conclusions: CDI incidence is higher in patients with hematologic malignancy. They also have worse outcomes including overall mortality, longer hospitalizations and discharge to healthcare facility. These patients warrant closer screening and prompt treatment of CDI as they are at greater risk of unfavorable outcomes. [Table: see text]

scholarly journals 780. How Much Does Prior Hospitalization Contribute to Readmission with Community-onset Clostridioides difficile Infection?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S434-S435
Author(s):  
Alice Guh ◽  
Lauren C Korhonen ◽  
Lisa Gail Winston ◽  
Brittany Martin ◽  
Helen Johnston ◽  
...  
Keyword(s):  
Care Facility ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Emerging Infections ◽  
Post Discharge ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Community Onset

Abstract Background Interventions to reduce community-onset (CO) Clostridioides difficile Infection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the proportion of admitted CO CDI that might be associated with previous hospitalization. Methods The CDC’s Emerging Infections Program conducts population-based CDI surveillance in 10 US sites. We defined an incident case as a C. difficile-positive stool collected in 2017 from a person aged ≥ 1 year admitted to a hospital with no positive tests in the prior 8 weeks. Cases were defined as CO if stool was collected within 3 days of hospitalization. CO cases were classified into four categories: long-term care facility (LTCF)-onset if patient was admitted from an LTCF; long-term acute care hospital (LTACH)-onset if patient was admitted from an LTACH; CO-healthcare-facility associated (CO-HCFA) if patient was admitted from a private residence but had a prior healthcare-facility admission in the past 12 weeks; or community-associated (CA) if there was no admission to a healthcare facility in the prior 12 weeks. We excluded hospitals with &lt; 10 cases among admitted catchment-area residents. Results Of 4724 cases in 86 hospitals, 2984 (63.2%) were CO (median per hospital: 65.8%; interquartile range [IQR]: 58.3%-70.7%). Among the CO cases, 1424 (47.7%) were CA (median per hospital: 48.1%; IQR: 40.3%-57.7%), 1201 (40.3%) were CO-HCFA (median per hospital: 41.0%; IQR: 32.9%-47.8%), 350 (11.7%) were LTCF-onset (median per hospital: 10.0%; IQR: 0.6%-14.4%), and 9 (0.3%) were LTACH-onset. Of 1201 CO-HCFA cases, 1174 (97.8%) had a prior hospitalization; among these, 978 (83.3%) (median per hospital: 83.3%; IQR: 69.2%-90.6%), which consists of 32.8% of all hospitalized CO cases, had been discharged from the same hospital (Figure), and 84.4% of the 978 cases (median per hospital: 88.2%: IQR: 76.5%-100.0%) had received antibiotics sometime in the prior 12 weeks. Figure. Frequency of Cases Discharged in the 12 Weeks Prior to Readmission with Clostridioides difficile Infection (N=1138*) Conclusion A third of hospitalized CO CDI had been recently discharged from the same hospital, and most had received antibiotics during or soon after the last admission. Hospital-based and post-discharge antibiotic stewardship interventions could help reduce subsequent CDI hospitalizations. Disclosures Ghinwa Dumyati, MD, Roche Diagnostics (Consultant)

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