#37: Clinical Characterization of the Cases Relating to the Outbreak of Clostridioides difficile, in a Third-level Hospital in Mexico City: Diagnosis, Treatment, and Relay

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Ortiz Samuel ◽  
Martínez María Elena ◽  
Morayta Ramírez A
Keyword(s):  
Antibiotic Use ◽  
Clinical Findings ◽  
Prevention Measures ◽  
Clostridioides Difficile ◽  
Young Infants ◽  
Plastic Bags ◽  
History Of ◽  
Initial Episode ◽  
Group Sex ◽  
Healthcare Associated

Abstract Background Clostridioides difficile is an important cause of healthcare-associated infections. The epidemiology of C. difficile infection (CDI) in children has changed over the past few decades. There is now a higher incidence in hospitalized children, and there has been an emergence of community-onset infection. Neonates and young infants have high rates of colonization but rarely have symptoms. The well-known risk factor for CDI in children age 2 years or older is antibiotic use. Inflammatory bowel disease and cancer are associated with increased incidence and severity of CDI. Vancomycin or fidaxomicin is recommended for an initial episode of CDI. In environments where access to Vancomycin or Fidaxomycin is limited, it is suggested to use metronidazole for an initial episode of nonsevere CDI only. Methods A series of cases were carried out, in a study period from March to May 2018, total cases 8; the age group, sex, basic diagnosis, clinical findings, diagnostic method, and outcome in hospitalized patients in the Pediatric division of the “CMN 20 de Noviembre, ISSSTE” were described, where there is a total of 377 Sensitive beds, and 53 beds in the pediatric area of which 30 are not sensitive. Results We analyzed 8 cases of diarrhea with identification of C. difficile, in a period of 3 months, where there was a total of 148 admissions to the division of Pediatrics (100%) and presented a prevalence of 0.05% of the total income. Of those 8 cases reported, 37.5% were women and 62.5% men; The age fluctuated between 6 months and 18 years. All children had associated comorbidities. The frequency and type of comorbidities were Cancer 87.5% (Leukemias and Solid Tumors) and Neurological 12.5% ​​(Arterial Malformation and Neurological Sequelae). The main symptom that occurred was mucous diarrhea in 100% of patients, abdominal pain in 25% and evacuation with blood in 12.5% ​​of cases. All had a history of prior treatment with 100% broad-spectrum antibiotics, in a period of less than one month. All were treated with metronidazole (100%) and all presented clinical improvement, without complications; Similarly, all were diagnosed by PCR for toxin B (100%). The attributable risk of presenting Clostridioides disease in patients with Leukemia is 0.11. Conclusions Patients with Leukemia were the most affected during the C. difficile outbreak, of which 11 out of 100 of these patients are at risk of presenting C. difficile disease. The most important thing in these cases is prevention. Therefore, specific prevention measures were implemented to reduce the possibility of future outbreaks, such as handwashing with chlorexidine, contact isolation, handwashing every time there is contact with the patient, use of gloves when performing procedures, insulation of bedding in plastic bags and training of health personnel.

Clostridioides difficile-induced diarrhoea following dasatinib therapy

2021 ◽  
Vol 14 (1) ◽  
pp. e239394
Author(s):  
Amlan Kusum Datta ◽  
Partha Debnath ◽  
Uddalak Chakraborty ◽  
Atanu Chandra
Keyword(s):  
Abdominal Pain ◽  
Kinase Inhibitor ◽  
Antibiotic Use ◽  
Chemotherapeutic Agents ◽  
Fluid Retention ◽  
Uneventful Recovery ◽  
Clostridioides Difficile ◽  
History Of ◽  
Etiological Agents ◽  
Oral Metronidazole

Dasatinib, an oral tyrosine kinase inhibitor, is approved for therapy of chronic myeloid leukaemia (CML). Common adverse effects of this therapy include myelosuppression, fluid retention and diarrhoea. However, Clostridioides difficile infections (CDIs) in the context of dasatinib therapy, without a history of antecedent antibiotic use, has not been reported previously. We present here a case of a 36-year-old man diagnosed with accelerated phase of CML, who was started on treatment with dasatinib. Two months into therapy, he experienced profuse diarrhoea and abdominal pain. Colonoscopy revealed multiple confluent colonic mucosal ulcerations. Immunoassay study of stool revealed positive C. difficile toxin. The patient was started on oral metronidazole, with discontinuation of all other drugs, including dasatinib. He made a complete uneventful recovery following 2 weeks of antibiotic therapy. Chemotherapeutic agents, such as dasatinib, should be considered as possible etiological agents in the pathogenesis of CDI, even in absence of antibiotic use.

scholarly journals 1016. Standardized Antimicrobial Administration Ratio (SAAR) and Clostridioides difficile Infection Standardized Infection Ratio (SIR): Are they connected? An Evaluation of 28 Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S357-S357
Author(s):  
Danielle Sebastian ◽  
Florian Daragjati ◽  
Karl Saake ◽  
Lisa K Sturm ◽  
Mohamad G Fakih
Keyword(s):  
Antimicrobial Agent ◽  
Broad Spectrum ◽  
Antibacterial Agents ◽  
Control Strategies ◽  
Antibiotic Use ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated ◽  
Antimicrobial Administration

Abstract Background Clostridioides difficile infections (CDIs) are the most prevalent healthcare-associated infection in the U.S. Of all CDIs, most are related to healthcare exposures and are potentially preventable by reducing unnecessary antibiotic use and interrupting patient-to-patient transmission of CDI. Methods The adult SAARs for 4 antimicrobial agent categories were compared with the CDI SIR at 28 facilities with greater than 100 beds across the health system for the calendar year of 2018. The 4 adult antimicrobial agent categories chosen for comparison were: antibacterial agents posing the highest risk for CDI, broad-spectrum antibacterial agents predominantly used for hospital-onset infections (BSHO), broad-spectrum antibacterial agents predominantly used for community-acquired infections (BSCA) and all antibacterial agents. Results The 2018 aggregate CDI SIR for the 28 facilities was 0.609. The aggregate SAAR for the adult antimicrobial agent categories were 1.05 for the antibacterial agents posing the highest risk for CDI, 1.05 for BSHO, 0.88 for BSCA, and 1.03 for all antibacterial agents. No correlation was seen between any of the 4 adult SAAR antimicrobial agent categories and the facility CDI SIR (Figure 1–4). Conclusion While reducing unnecessary antibiotics is an important strategy in preventing CDIs, having a higher observed vs. predicted administration ratio in the four antimicrobial agent categories studied was not correlated with a higher CDI SIR, including the CDI SAAR category. Reduction of CDI is challenging requiring a multipronged approach to include infection control strategies, appropriate testing, and antimicrobial stewardship. Disclosures All authors: No reported disclosures.

scholarly journals Broad-spectrum antibiotic use and poor outcomes in community-onset pneumonia: a cohort study

2019 ◽  
Vol 54 (1) ◽  
pp. 1900057 ◽  
Author(s):  
Brandon J. Webb ◽  
Jeff Sorensen ◽  
Al Jephson ◽  
Ian Mecham ◽  
Nathan C. Dean
Keyword(s):  
Cohort Study ◽  
Broad Spectrum ◽  
Antibiotic Use ◽  
Average Treatment Effect ◽  
Broad Spectrum Antibiotic ◽  
Clostridioides Difficile ◽  
Broad Spectrum Antibiotics ◽  
Poor Outcomes ◽  
Healthcare Associated ◽  
Community Onset

QuestionIs broad-spectrum antibiotic use associated with poor outcomes in community-onset pneumonia after adjusting for confounders?MethodsWe performed a retrospective, observational cohort study of 1995 adults with pneumonia admitted from four US hospital emergency departments. We used multivariable regressions to investigate the effect of broad-spectrum antibiotics on 30-day mortality, length of stay, cost and Clostridioides difficile infection (CDI). To address indication bias, we developed a propensity score using multilevel (individual provider) generalised linear mixed models to perform inverse-probability of treatment weighting (IPTW) to estimate the average treatment effect in the treated. We also manually reviewed a sample of mortality cases for antibiotic-associated adverse events.Results39.7% of patients received broad-spectrum antibiotics, but drug-resistant pathogens were recovered in only 3%. Broad-spectrum antibiotics were associated with increased mortality in both the unweighted multivariable model (OR 3.8, 95% CI 2.5–5.9; p<0.001) and IPTW analysis (OR 4.6, 95% CI 2.9–7.5; p<0.001). Broad-spectrum antibiotic use by either analysis was also associated with longer hospital stay, greater cost and increased CDI. Healthcare-associated pneumonia was not associated with mortality independent of broad-spectrum antibiotic use. In manual review we identified antibiotic-associated events in 17.5% of mortality cases.ConclusionBroad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia.

scholarly journals Potential Roles for Probiotics in the Treatment of COVID-19 Patients and Prevention of Complications Associated with Increased Antibiotic Use

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 408
Author(s):  
Ravina Kullar ◽  
Stuart Johnson ◽  
Lynne V. McFarland ◽  
Ellie J. C. Goldstein
Keyword(s):  
Medical Care ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Ventilator Associated Pneumonia ◽  
Empiric Antibiotics ◽  
Clostridioides Difficile ◽  
Secondary Infections ◽  
Antibiotic Associated Diarrhea ◽  
Potential Strategy ◽  
Healthcare Associated

Medical care for patients hospitalized with COVID-19 is an evolving process. Most COVID-19 inpatients (58–95%) received empiric antibiotics to prevent the increased mortality due to ventilator-associated pneumonia and other secondary infections observed in COVID-19 patients. The expected consequences of increased antibiotic use include antibiotic-associated diarrhea (AAD) and Clostridioides difficile infections (CDI). We reviewed the literature (January 2020–March 2021) to explore strategies to reduce these consequences. Antimicrobial stewardship programs were effective in controlling antibiotic use during past influenza epidemics and have also been shown to reduce healthcare-associated rates of CDI. Another potential strategy is the use of specific strains of probiotics shown to be effective for the prevention of AAD and CDI prior to the pandemic. During 2020, there was a paucity of published trials using these two strategies in COVID-19 patients, but trials are currently ongoing. A multi-strain probiotic mixture was found to be effective in reducing COVID-19-associated diarrhea in one trial. These strategies are promising but need further evidence from trials in COVID-19 patients.

scholarly journals 803. Risk factors associated with Clostridioides difficile infection in hospitalized patients with community-acquired pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S445-S445
Author(s):  
William Justin Moore ◽  
Caroline C Jozefczyk ◽  
Paul R Yarnold ◽  
Karolina Harkabuz ◽  
Valerie Widmaier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decomposition Analysis ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Structural Decomposition Analysis ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Pre Treatment ◽  
Healthcare Associated

Abstract Background Patients with community-acquired pneumonia (CAP) who are hospitalized and treated with antibiotics may carry an increased risk for developing Clostridioides difficile infection (CDI). Accurate risk estimation tools are needed to guide monitoring and CDI mitigation efforts. We aimed to identify patient-specific risk factors associated with CDI among hospitalized patients with CAP. Methods Design: retrospective case-control study of hospitalized patients who received CAP-directed antibiotic therapy between 1/1/2014 and 5/29/2018. Cases were hospitalized CAP patients who developed CDI post-admission. Control patients did not develop CDI and were selected at random from CAP patients hospitalized during this period. Variables: comorbidities, laboratory results, vital signs, severity of illness, prior hospitalization, and past antibiotic use. Propensity-score weights: identified via structural decomposition analysis of pre-treatment variables. Analysis: weighted classification tree models that predicted any CDI, hospital-onset CDI, and any healthcare-associated CDI according to CAP antibiotic treatment. Performance: percent accuracy in classification (PAC) and weighted positive (PPV) and negative predictive values (NPV). Modeling: completed using the ODA package (v1.0.1.3) for R (v3.5.1). Results A total of 32 cases and 232 controls were identified. Sixty pre-treatment variables were screened. Structural decomposition analysis, completed in two stages, identified prior hospitalization (OR 6.56, 95% CI: 3.01-14.31; PAC: 80.3%) and BUN greater than 29 mg/dL (OR 11.67, 95% CI: 2.41-56.5; PAC: 80.8%) as propensity-score weights. With respect to CDI, receipt of broad-spectrum anti-pseudomonal antibiotics was significantly (all P’s&lt; 0.05) associated with any CDI (NPV: 90.29%, PPV: 27.94%), hospital-onset CDI (NPV: 97.53%, PPV: 26.86%), and healthcare-associated CDI (NPV: 92.89%, PPV: 27.94%). Conclusion We identified risk factors available at hospital admission and empiric use of broad-spectrum Gram-negative antibiotics as being associated with the development of CDI. Model PPVs were over two-fold greater than our sample base rate. Increased monitoring and avoidance of overly broad antibiotic use in high-risk patients appears warranted. Disclosures All Authors: No reported disclosures

scholarly journals Clostridium difficile Infection: An Epidemiology Update

2020 ◽  
Vol 33 (02) ◽  
pp. 049-057 ◽  
Author(s):  
Ana C. De Roo ◽  
Scott E. Regenbogen
Keyword(s):  
Risk Factors ◽  
Antibiotic Use ◽  
Recurrence Risk ◽  
Epidemiologic Studies ◽  
High Morbidity ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Hospitalized Older Adults ◽  
Healthcare Associated

Abstract Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

scholarly journals 721. Effect of Gastrointestinal Pathogen Panel (GIP) in Antibiotic Management

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S411-S411
Author(s):  
Christopher F Saling ◽  
Maria T Seville ◽  
Roberto L Patron
Keyword(s):  
Escherichia Coli ◽  
High Sensitivity ◽  
Antibiotic Use ◽  
Turnaround Time ◽  
Enterotoxigenic Escherichia Coli ◽  
Antibiotic Overuse ◽  
Panel Testing ◽  
Clostridioides Difficile ◽  
Antibiotic Management ◽  
History Of

Abstract Background GIP offers detection via PCR for a wide array of common microbes associated with diarrheal illness. Its rapid turnaround time and high sensitivity has made GIP testing commonplace for the evaluation of diarrhea. The purpose of this study is to determine if GIP influences antibiotic management in patients hospitalized with diarrhea. Methods Fifty patients hospitalized at Mayo Clinic Arizona between July and December 2019 who underwent BioFire® FilmArray™ GI PCR Panel testing were randomly selected. Medical records were reviewed to capture gender, age, immunocompromised state, antibiotic use within 30 days, prior hospitalization within 3 months, history of Clostridioides difficile infection, time from admission to testing and GIP results, and to determine if GIP results directly contributed towards antibiotic management. This study was exempt from Institutional Review Board approval. Results Twenty-six patients were male and twenty-four were female. The average age was 61.7 years. Thirty-four patients (68%) were immunocompromised. Forty-one GIPs were ordered within 24 hours of admission. Twenty-two patients (44%) had a positive GIP result; five were positive for 2 concurrent organisms. C. difficile was the most commonly detected organism, found in 16/24 (66.7%) positive tests. Eleven patients (68.8%) with C. difficile had a recent hospitalization, antibiotics within 30 days, or a history of C. difficile infection. There were 3 cases of Enteropathogenic Escherichia coli, 2 of Enterotoxigenic Escherichia coli, 2 of adenovirus, 2 of norovirus, 1 of rotavirus, and 1 of Vibrio cholerae. Excluding C. difficile positive patients, GIP testing contributed in changing antibiotic management in 3/50 (6%) patients tested. One patient had antibiotics stopped, one received correct antibiotics, and one received inappropriate antimicrobial therapy. Conclusion These results suggest that except in the setting of C. difficile infection, GIP has little utility in guiding antimicrobial management, even in the immunocompromised patient. GIP testing is expensive and it may be more resourceful to screen patients hospitalized with diarrhea for C. difficile alone, especially in those with risk factors for C. difficile infection. Furthermore, GIP testing can lead to antibiotic overuse. Disclosures All Authors: No reported disclosures

scholarly journals 2378. Corticosteroid Use Prevents Primary Clostridioides difficile Infection in the Setting of Broad-Spectrum Antibiotic Use Among Hospitalized Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S820-S820
Author(s):  
Travis J Carlson ◽  
Melissa F Wilcox ◽  
Sarah G Theriault ◽  
Faris S Alnezary ◽  
Anne J Gonzales-Luna ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
The United States ◽  
Case Control ◽  
Hospitalized Patients ◽  
Primary Study ◽  
Care Hospital ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
History Of

Abstract Background Clostridioides difficile is the most common pathogen causing healthcare-associated infections in the United States and a Centers for Disease Control and Prevention urgent threat-level pathogen. The pathophysiology of C. difficile infection (CDI) involves neutrophil invasion of the colon associated with an inflammatory response. Previous case–control studies investigating an anti-inflammatory corticosteroid (CS) effect on CDI risk demonstrated conflicting results but were unable to control for antibiotic use. We hypothesized that CS use would decrease the risk of CDI in a well-matched, high-risk population. Methods This nested case–control study included hospitalized patients admitted to a single quaternary care hospital in the Texas Medical Center. The case population included adults who were diagnosed with CDI and received at least one dose of an antibiotic of interest (piperacillin–tazobactam, cefepime, or meropenem) in the 90 days prior to CDI diagnosis. The control population included hospitalized adults who received one of the same antibiotics during their hospital stay but did not develop CDI in the 90 days following their first dose. Patients were excluded if they had a documented history of CDI. CS use was defined as ≥ 20 mg prednisone or equivalent administered in the 48 hours prior to CDI diagnosis (cases) or antibiotic start (controls). The primary study outcome was the development of CDI. A logistic regression model was developed modeling CDI diagnosis as a function of available patient covariates. Results A total of 321 patients met the inclusion criteria; 56 patients had a history of CDI, leaving a final study cohort of 265 patients (104 cases and 161 controls). Antibiotic days of therapy were significantly higher in the control group (8 vs. 6 days; P = 0.02). The odds of CDI diagnosis were lower among patients administered CS (OR, 0.17; 95% CI, 0.08–0.38; P < 0.001), which remained protective in the multivariable model after adjusting for age, gender, and invasive GI surgery within 6 months. Conclusion We observed an association between CS use and decreased risk of developing primary CDI in hospitalized patients receiving broad-spectrum antibiotics. Future studies are needed to delineate the dose and duration of CS needed to realize this effect. Disclosures All authors: No reported disclosures.

scholarly journals Infection with Clostridioides difficile ribotype 046 in a paediatric liver transplant patient

2021 ◽  
Vol 3 (10) ◽  
Author(s):  
Hildenia B. R. Nogueira ◽  
Cecília L. Costa ◽  
Conceição S. Martins ◽  
Maria Luana G. S. Morais ◽  
Carlos Quesada-Gómez ◽  
...  
Keyword(s):  
Molecular Characterization ◽  
Type Species ◽  
Transplant Patient ◽  
Antibiotic Use ◽  
Female Child ◽  
Content Type ◽  
Link Type ◽  
Clostridioides Difficile ◽  
History Of

Clostridioides difficile causes nosocomial diarrhoea associated with antibiotic use and immunodeficiency. Although the number of paediatric C. difficile infections (CDIs) has increased worldwide, there are few studies on the molecular characterization of strains causing CDIs among children. We report the clinical features and strain molecular characterization of a CDI in a female child with a history of liver transplantation at 7 months of age. This is the first report of the 046 ribotype causing paediatric diarrhoea.

scholarly journals Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Eliza Manea ◽  
Raluca Jipa ◽  
Alexandru Milea ◽  
Antonia Roman ◽  
Georgiana Neagu ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Group Versus ◽  
Antibiotic Use ◽  
Similar Rate ◽  
Antimicrobial Treatment ◽  
Care Hospital ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated

Abstract Introduction Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic. Methods We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018. Results We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days). Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment – mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group. Conclusions The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19. What is important: Information on healthcare-acquired C.difficile in COVID-19 patients is limited, but not only C.difficile infection remains a worrying issue, but is also an emerging topic. We found that antibiotic use seems to be the most important factor associated with CDI and our data emphasize the need for rational use of antibiotics and for ongoing attention regarding CDI in COVID-19 patients.

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