Certain Rooms in Intensive Care Units May Harbor Risk for Clostridioides difficile Infection

Abstract Background : Clostridioides difficile is considered to be the main pathogen responsible for hospital-acquired infections. This study performed a prospective study to describe the prevalence, molecular epidemiological characteristics and risk factors of Clostridioides difficile infection (CDI) and Clostridioides difficile colonization (CDC) among patients in intensive care units (ICUs), a tertiary hospital in China, with the aim of providing strategies for efficient CD prevention and control. Methods: Stool samples were collected and anaerobically cultured for C. difficile . The identified isolates were tested for toxin genes and multi-locus sequence typing. The medical records of patients who were divided into CDI, CDC and control groups were collected and analyzed to investigate the risk factors. Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) patients were identified with CDI and CDC, respectively. An association was found between CDI patients and having a fever (OR=13.993) or metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or a combination of antibiotics (OR=2.856). CDC patients were characterized by longer hospital stays (OR=1.137), an increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043) and treatment with vancomycin (OR=18.168). Significantly, treatment with metronidazole was simultaneously found to be a protective factor in the two groups (OR=0.042; OR=0.013). Eighteen sequence types (STs) were identified. Among the CDI group, the isolates were predominantly toxin A and toxin B positive (A+B+) strains and genotype ST2 was the epidemic clone. In the CDC group, the dominant strains were A+B+ and ST81 was the epidemic clone. Conclusions: The prevalence of CDC and CDI in our ICUs was relatively high, suggesting the importance of routine screening to detect the acquisition of this pathogen. Future prevention and treatment strategies for C. difficile -related disease should consider hospital stays, enteral nutrition, underlying comorbidities, and the use of combined antibiotics. Moreover, metronidazole could be a protective factor for both CDI and CDC, which could be used empirically .

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Healthcare Associated Infections—A New Pathology in Medical Practice?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17030760 ◽

2020 ◽

Vol 17 (3) ◽

pp. 760 ◽

Cited By ~ 2

Author(s):

Septimiu Voidazan ◽

Sorin Albu ◽

Réka Toth ◽

Bianca Grigorescu ◽

Anca Rachita ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Acinetobacter Baumannii ◽

Intensive Care Units ◽

Public Hospitals ◽

Hospital Acquired Infections ◽

Clostridioides Difficile ◽

Tract Infections ◽

Hospital Acquired

Background: Hospital-acquired infections (HAI) contribute to the emotional stress and functional disorders of the patient and in some cases, can lead to a state of disability that reduces quality of life. Often, HAI are one of the factors that lead to death. The purpose of this study was to analyze the cases of HAI identified in public hospitals at the county level, through case report sheets, as they are reported according to the Romanian legislation. Methods: We performed a cross sectional study design based on the case law of the data reported to the Mures Public Health Directorate, by all the public hospitals belonging to this county. We tracked hospital-acquired infections reported for 2017–2018, respectively, a number of 1024 cases, which implies a prevalence rate of 0.44%, 1024/228,782 cases discharged from these hospitals during the studied period. Results: The most frequent HAIs were reported by the intensive care units (48.4%), the most common infections being the following: bronchopneumonia (25.3%), enterocolitis with Clostridioides difficile (23.3%), sepsis, surgical wound infections and urinary tract infections. At the basis of HAI were 22 pathogens, but the five most common germs were Clostridioides difficile, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Bronchopneumonia have been most frequently reported in intensive care units, the most common being identified the Acinetobacter baumannii agent. Sepsis and central catheter infections also appeared predominantly in intensive care units, more often with Klebsiella pneumoniae. The enterocolitis with Clostridioides difficile, were the apanage of the medical sections. Infections with Staphylococcus aureus have been identified predominantly in the surgical sections at the level of the surgical wounds. Urinary infections had a similar distribution in the intensive care units, the medical and surgical sections, with Klebsiella pneumoniae being the most commonly incriminated agent. Conclusions: We showed a clear correspondence between the medical units and the type of HAI: what recommends the rapid, vigilant and oriented application of the prevention and control strategies of the HAI.

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Prevalence of Clostridioides difficile Infection in Critically Ill Patients with Extreme Leukocytosis and Diarrhea

Infectious Disease Reports ◽

10.3390/idr13010003 ◽

2021 ◽

Vol 13 (1) ◽

pp. 18-22

Author(s):

Bijan Teja ◽

Nafeesa Alibhai ◽

Gordon D. Rubenfeld ◽

Linda R. Taggart ◽

Naheed Jivraj ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clostridium Difficile ◽

Critically Ill ◽

Critically Ill Patients ◽

Empiric Antibiotic Therapy ◽

Empiric Treatment ◽

Clostridioides Difficile ◽

Empiric Antibiotic ◽

Clostridioides Difficile Infection

While early empiric antibiotic therapy is beneficial for patients presenting with sepsis, the presentation of sepsis from Clostridioides difficile (formerly Clostridium difficile) infection (CDI) has not been well studied in large cohorts. We sought to determine whether the combination of extreme leukocytosis and diarrhea was strongly predictive of CDI in a cohort of 8659 patients admitted to the intensive care unit. We found that CDI was present in 15.0% (95% CI, 12.1–18.3%) of patients with extreme leukocytosis and diarrhea and that mortality for those with CDI, diarrhea, and extreme leukocytosis was 33.8% (95% CI, 23.2–44.3%). These data support consideration of empiric treatment for CDI in unstable critically ill patients with extreme leukocytosis and diarrhea, along with treatment of other possible sources of sepsis as appropriate. Empiric treatment for CDI can usually be discontinued promptly, along with narrowing of other broad-spectrum antimicrobial coverage, if a sensitive C. difficile test is negative.

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Risk factors and Intestinal Microbiota: Clostridioides difficile Infection in Patients Receiving Enteral Nutrition at Intensive Care Unit

10.21203/rs.3.rs-16899/v1 ◽

2020 ◽

Author(s):

Daosheng Wang ◽

Danfeng Dong ◽

Chen Wang ◽

Yingchao Cui ◽

Cen Jiang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Enteral Nutrition ◽

Intestinal Microbiota ◽

Intestinal Microbiome ◽

Clostridioides Difficile ◽

Nosocomial Diarrhea ◽

Clostridioides Difficile Infection ◽

Clinical Records

Abstract Background: Clostridioides difficile infection (CDI) is a leading cause of nosocomial diarrhea. Patients receiving enteral nutrition (EN) in the intensive care unit (ICU) are potentially at high risk of CDI. Presently, we assessed the risk factors and intestinal microbiome of these patients to better understand the occurrence and development of CDI. Methods: Patients were screened for C. difficile every week after EN started and their clinical records were collected for risk factor identification. Feces were analyzed for 16S rRNA sequencing to evaluate the intestinal microbiota. Results : Overall incidence of CDI was 10.7% (18/168 patients). History of cerebral infarction was associated with CDI occurrence (OR, 9.759; 95% CI, 2.140-44.498) and treatment with metronidazole could be protective (OR, 0.287; 95% CI, 0.091-0.902). Patients with EN had lower microbial richness and diversity, accompanied by reduced abundance of Bacteroides , Prevotella_9, Ruminococcaceae and Lachnospiraceae. Of these patients, acquisition of C. difficile resulted in a transient increase in microbial diversity, along with consistent alterations in the proportion of some bacterial taxa, especially Ruminococcaceae and Lachnospiraceae. At the initiation of EN, patients who were positive for C. difficile later had enhanced abundance of Bacteroides , which was negatively correlated with C. difficile load when CDI developed. Conclusion : ICU patients receiving EN had a high prevalence of CDI, and a fragile intestinal microbial environment. Alteration of microbiota composition could be vital in the process of CDI development, bringing new insights in the interaction between C. difficile and host microbiome.

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