scholarly journals 758. Increased Prevalence of Clostridioides difficile Infection During the COVID-19 Pandemic Among Hospitalized Veterans in South Texas, USA

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S476-S477
Author(s):  
Eric H Young ◽  
Erica Beck ◽  
Delvina Ford ◽  
Julieta Madrid-Morales ◽  
Ann Hoffman ◽  
...  
Keyword(s):  
Healthcare Facility ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
South Texas ◽  
Health Concern ◽  
Veterans Health ◽  
Global Public Health ◽  
Cross Sectional ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infection (CDI) continues to be a major global public health concern, particularly during the ongoing SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic. Despite new social distancing guidelines and enhanced infection control procedures (e.g., masking, hand hygiene) being implemented since the beginning of COVID-19, little evidence indicates whether these changes have influenced the prevalence of CDI hospitalizations. This study aims to measure CDI prevalence before and during the COVID-19 pandemic in a local cohort of U.S. Veterans. Methods This was a cross-sectional study of all Veterans presenting to the South Texas Veterans Health Care System in San Antonio, Texas from Jan 1, 2019 to Apr 30, 2021. Monthly laboratory confirmed CDI events were collected overall and categorized as the following: hospital-onset, healthcare facility-associated (HO-HCFA-CDI), community-onset, healthcare facility-associated CDI (CO-HCFA-CDI), and community-associated CDI (CA-CDI). Monthly confirmed COVID-19 cases were also collected. CDI prevalence was calculated as CDI events per 10,000 bed days of care (BDOC) and was compared between pre-pandemic (Jan 2019-Feb 2020) and pandemic (Mar 2020-Apr 2021) periods. Results A total of 285 CDI events, 920 COVID-19 cases, and 104,220 BDOC were included in this study. The overall CDI rate increased from 20.33 per 10,000 BDOC pre-pandemic to 34.51 per 10,000 during the pandemic (p< 0.0001). This was driven primarily by a rise in CO-HCFA-CDI rates (0.95 vs 2.52 per 10,000 BDOC; p< 0.0001) during the pandemic, followed by increases in CA-CDI (15.58 vs. 18.61 per 10,000 BDOC; p< 0.0001) and HO-HCFA-CDI (2.66 vs. 5.43 per 10,000 BDOC; p< 0.0001). Lastly, CDI rates have tripled since the start of the pandemic (March-Apr 2020) compared to the current year (March-Apr 2021) (14.69 vs. 43.76 per 10,000 BDOC). Conclusion Overall, CDI prevalence increased during the COVID-19 pandemic, driven mostly by an increase in CO-HCFA-CDI. As COVID-19 rates increased, CDI rates also increased, likely due to greater healthcare exposures and antibiotic use. Continued surveillance of COVID-19 and CDI is warranted to further decrease infection rates Disclosures All Authors: No reported disclosures

scholarly journals Correlation of prevention practices with rates of health care-associated Clostridioides difficile infection

2019 ◽  
Vol 41 (1) ◽  
pp. 52-58
Author(s):  
Jackson S. Musuuza ◽  
Linda McKinley ◽  
Julie A. Keating ◽  
Chidi Obasi ◽  
Mary Jo Knobloch ◽  
...  
Keyword(s):  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Contact Precautions ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Bed Days ◽  
Acute Care Facilities

AbstractObjective:We examined Clostridioides difficile infection (CDI) prevention practices and their relationship with hospital-onset healthcare facility-associated CDI rates (CDI rates) in Veterans Affairs (VA) acute-care facilities.Design:Cross-sectional study.Methods:From January 2017 to February 2017, we conducted an electronic survey of CDI prevention practices and hospital characteristics in the VA. We linked survey data with CDI rate data for the period January 2015 to December 2016. We stratified facilities according to whether their overall CDI rate per 10,000 bed days of care was above or below the national VA mean CDI rate. We examined whether specific CDI prevention practices were associated with an increased risk of a CDI rate above the national VA mean CDI rate.Results:All 126 facilities responded (100% response rate). Since implementing CDI prevention practices in July 2012, 60 of 123 facilities (49%) reported a decrease in CDI rates; 22 of 123 facilities (18%) reported an increase, and 41 of 123 (33%) reported no change. Facilities reporting an increase in the CDI rate (vs those reporting a decrease) after implementing prevention practices were 2.54 times more likely to have CDI rates that were above the national mean CDI rate. Whether a facility’s CDI rates were above or below the national mean CDI rate was not associated with self-reported cleaning practices, duration of contact precautions, availability of private rooms, or certification of infection preventionists in infection prevention.Conclusions:We found considerable variation in CDI rates. We were unable to identify which particular CDI prevention practices (i.e., bundle components) were associated with lower CDI rates.

scholarly journals Microbiota in Clostridioides difficile-Associated Diarrhea: Comparison in Recurrent and Non-Recurrent Infections

Biomedicines ◽  
2020 ◽  
Vol 8 (9) ◽  
pp. 335 ◽  
Author(s):  
Alessandra Gazzola ◽  
Simona Panelli ◽  
Marta Corbella ◽  
Cristina Merla ◽  
Francesco Comandatore ◽  
...  
Keyword(s):  
Fecal Microbiota ◽  
Taxonomic Composition ◽  
Health Concern ◽  
Global Public Health ◽  
Related Factors ◽  
Clostridioides Difficile ◽  
Hospitalized Elderly ◽  
Clinical Presentations ◽  
Clostridioides Difficile Infection

Clostridioides difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea, especially in hospitalized elderly patients, representing a global public health concern. Clinical presentations vary from mild diarrhea to severe pseudomembranous colitis that may progress to toxic megacolon or intestinal perforation. Antibiotic therapy is recognized as a risk factor and exacerbates dysbiosis of the intestinal microbiota, whose role in CDI is increasingly acknowledged. A clinically challenging complication is the development of recurrent disease (rCDI). In this study, using amplicon metagenomics, we compared the fecal microbiota of CDI and rCDI patients (sampled at initial and recurrent episode) and of non-infected controls. We also investigated whether CDI severity relates to specific microbiota compositions. rCDI patients showed a significantly decreased bacterial diversity as compared to controls (p < 0.01). The taxonomic composition presented significant shifts: both CDI and rCDI patients displayed significantly increased frequencies of Firmicutes, Peptostreptococcaceae, Clostridium XI, Clostridium XVIII, and Enterococcaceae. Porphyromonadaceae and, within it, Parabacteroides displayed opposite behaviors in CDI and rCDI, appearing discriminant between the two. Finally, the second episode of rCDI was characterized by significant shifts of unclassified Clostridiales, Escherichia/Shigella and Veillonella. No peculiar taxa composition correlated with the severity of infection, likely reflecting the role of host-related factors in determining severity.

scholarly journals The prevalence of asthma among children in South Africa is increasing - is the need for medication increasing as well? A case study in the Vaal Triangle

2014 ◽  
Vol 24 (1) ◽  
pp. 28-30
Author(s):  
M.A. Oosthuizen ◽  
A.J. Mundackal ◽  
C.Y. Wright
Keyword(s):  
Cross Sectional Study ◽  
Health Concern ◽  
Health Study ◽  
Global Public Health ◽  
Cross Sectional ◽  
Respiratory Illnesses ◽  
Chronic Inflammatory Condition ◽  
Study Population ◽  
The Difference ◽  
Vaal Triangle

Asthma, a chronic inflammatory condition of the airways, is a global public health concern. In southern Africa the prevalence of asthma has increased over the last few decades. In the current study, all 10-year-old learners from three of the schools (one each in Sasolburg, Vanderbijlpark and Vereeniging) that participated in the 1990 Vaal Triangle Air Pollution and Health Study, were selected as the study population for a cross-sectional study conducted in 2010. Both the 1990 and 2010 studies investigated several exposure factors but focussed on respiratory illnesses as main health outcomes. Although the overall ethnicity profile in 2010 was different from that of 1990, the socioeconomic status of the study populations were very similar – the reason being that the same schools were used and the participating children were from the same immediate environment. The results of the 2010 study were then compared to the results of all 10-year-olds, from the same three schools, who participated in the 1990 study. The results showed the difference in prevalence of asthma during the two study years was statistically significant. The difference in the percentage of children who had ever been diagnosed with asthma and were reportedly on medication in 1990 and 2010 was, however, not statistically significant, indicating that although the prevalence of asthma increased, the demand for medication to control the condition may not have increased as well.

scholarly journals Utilisation of healthcare services for respiratory tract infections in patients with and without diabetes in Qatar: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041761
Author(s):  
Nazmul Islam ◽  
Tawanda Chivese ◽  
M Fasihul Alam
Keyword(s):  
Respiratory Tract Infections ◽  
Healthcare Facility ◽  
Antibiotic Use ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Diabetes Diagnosis ◽  
Electronic Database ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tract Infections

ObjectivePeople with diabetes mellitus have a high risk of acquiring respiratory tract infections (RTIs), yet little is known about their utilisation of healthcare services compared with people without diabetes. This study aimed to compare the utilisation of healthcare services for RTIs between individuals with and without diabetes attending primary healthcare centres (PHCCs) in Qatar.DesignA retrospective cross-sectional study was conducted using an electronic database of all individuals who had a diagnosis of RTI.SettingPHCCs in Qatar from July 2015 to December 2017.ParticipantsParticipants in the study were all adult individuals (aged ≥18 years) who visited the primary healthcare facilities and were diagnosed with an RTI during the study period.Primary and outcome measuresFor each participant, visits to the healthcare facility, antibiotic use and use of other medications were extracted from the electronic database and compared between participants with and without a diabetes diagnosis.ResultsA total of 32 857 participants were included, of whom 7407 (22.5%) had a diabetes diagnosis. Results from a negative binomial regression indicate that diabetes diagnosis was significantly associated with increased visits to the healthcare facility (incidence rate ratio (IRR) 1.10, 95% CI 1.076 to 1.134, p<0.001), antibiotic use (IRR 1.09, 95% CI 1.046 to 1.145, p<0.001) and use of other medications (IRR 1.11, 95% CI 1.078 to 1.143, p<0.001).ConclusionsA diabetes diagnosis among patients with RTI was associated with higher utilisation of healthcare services. Given the added costs to the healthcare system, prevention of diabetes will have additional benefits to the healthcare system, apart from diabetes-associated costs alone.

scholarly journals The Association Between Tobacco Exposure During Pregnancy and Newborns’ Birth Weight in DKI Jakarta Community Members

2020 ◽  
Author(s):  
Jason Phowira ◽  
Felicitas Tania Elvina ◽  
Igor Ian Wiguna ◽  
Fathurohman Ramadhan Hanif Bari Wahyudi ◽  
Bernie Endyarni Medise
Keyword(s):  
Birth Weight ◽  
Smoking Status ◽  
Cross Sectional Study ◽  
Health Concern ◽  
Premature Delivery ◽  
Global Public Health ◽  
Tobacco Exposure ◽  
Cross Sectional ◽  
Smoking During Pregnancy ◽  
Paternal Smoking

AbstractLow birth weight (LBW), a major determinant of neonate morbidity and mortality, remains a global public health concern. Intrauterine exposure to tobacco has been discerned as an important risk factor for LBW. This study aims to investigate the association between parental smoking during pregnancy and LBW. An analytical cross-sectional study was conducted from December 2019 - July 2020 on a random sample of parents with child aged 0-5 years old from 5 health centers in DKI Jakarta, Indonesia. A total of 145 subjects met the criteria and were analysed. Data analysis was carried out using IBM SPSS Statistics software. In the study, 11% of infants were born with LBW. The prevalence of smoking in fathers and mothers were 55.2% and 3.4%, respectively. Paternal smoking status was significantly associated with LBW (p < 0.05). Although not statistically significant, there was a dose-response relationship between paternal number of cigarettes/day and duration of smoking with LBW. Maternal smoking status (p = 0.448) was not closely associated with LBW, which might be due limited number of actively smoking mothers. From multivariate logistic regression, paternal smoking status, premature delivery, birth order and inadequate food intake during pregnancy were significant predictors of LBW (p < 0.05).

Pyrazinamide Induced Hyperuricemia in the Induction Phase of Anti-Tuberculosis Therapy

2021 ◽  
Vol 15 (5) ◽  
pp. 1136-1138
Author(s):  
N. Muhammad ◽  
S. Mehboob ◽  
M. Abbas
Keyword(s):  
Uric Acid ◽  
Serum Uric Acid ◽  
Cross Sectional Study ◽  
Health Concern ◽  
Induction Phase ◽  
Global Public Health ◽  
Metabolic Disturbances ◽  
Cross Sectional ◽  
Intensive Phase ◽  
Increased Risk

Background: Tuberculosis (TB) is a global public health concern; although there are several recognized anti-tuberculosis drugs (ATDs) that effectively combat Mycobacterium tuberculosis (MTB), the associated adverse effects lead to frequent discontinuation. Objective: To assess the metabolic disturbances resulting from Pyrazinamide, the altered serum uric acid (SUA) levels among TB patients in District Bunir. Study Design: Cross-sectional study Place and Duration of Study: Department of Medicine, Bilal Medical Trust Hospital, Bunir-KPK from 1st January to 30th September 2019. Methodology: One hundred and nine tuberculosis patients were included in the study. All these patients were on ATD with Pyrazinamide and were regularly followed up, and their SUA levels were determined at weeks 0, 4 and 8. Results: The serum uric acid levels were high in almost 85.3% in the intensive phase of anit-TB Therapy (ATT). Among female TB patients, the incidence rate of hyperuricemia was comparatively higher than males (88.1% vs. 81.0%), but there were no significant gender disparities. Conclusion: The anti-tuberculosis drug with pyrazinamide is associated with an increased risk of hyperuricemia. Therefore, the illness needs to be closely monitored during the intensive phase of therapy. Key words: Pyrazinamide, Tuberculosis, Hyperuricaemia

scholarly journals Association Between Antibiotic Use and Hospital-onset Clostridioides difficile Infection in US Acute Care Hospitals, 2006–2012: An Ecologic Analysis

2019 ◽  
Vol 70 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Sophia V Kazakova ◽  
James Baggs ◽  
L Clifford McDonald ◽  
Sarah H Yi ◽  
Kelly M Hatfield ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Fourth Generation ◽  
Cross Sectional ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background Unnecessary antibiotic use (AU) contributes to increased rates of Clostridioides difficile infection (CDI). The impact of antibiotic restriction on hospital-onset CDI (HO-CDI) has not been assessed in a large group of US acute care hospitals (ACHs). Methods We examined cross-sectional and temporal associations between rates of hospital-level AU and HO-CDI using data from 549 ACHs. HO-CDI was defined as a discharge with a secondary International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI (008.45), and treatment with metronidazole or oral vancomycin &gt; 3 days after admission. Analyses were performed using multivariable generalized estimating equation models adjusting for patient and hospital characteristics. Results During 2006–2012, the unadjusted annual rates of HO-CDI and total AU were 7.3 per 10 000 patient-days (PD) (95% confidence interval [CI], 7.1–7.5) and 811 days of therapy (DOT)/1000 PD (95% CI, 803–820), respectively. In the cross-sectional analysis, for every 50 DOT/1000 PD increase in total AU, there was a 4.4% increase in HO-CDI. For every 10 DOT/1000 PD increase in use of third- and fourth-generation cephalosporins or carbapenems, there was a 2.1% and 2.9% increase in HO-CDI, respectively. In the time-series analysis, the 6 ACHs with a ≥30% decrease in total AU had a 33% decrease in HO-CDI (rate ratio, 0.67 [95% CI, .47–.96]); ACHs with a ≥20% decrease in fluoroquinolone or third- and fourth-generation cephalosporin use had a corresponding decrease in HO-CDI of 8% and 13%, respectively. Conclusions At an ecologic level, reductions in total AU, use of fluoroquinolones, and use of third- and fourth-generation cephalosporins were each associated with decreased HO-CDI rates.

scholarly journals Antibiotic Use: A Cross-Sectional Study Evaluating the Understanding, Usage and Perspectives of Medical Students and Pathfinders of a Public Defence University in Malaysia

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 154 ◽  
Author(s):  
Mainul Haque ◽  
Nor Azlina A. Rahman ◽  
Judy McKimm ◽  
Massimo Sartelli ◽  
Golam Mohammad Kibria ◽  
...  
Keyword(s):  
Medical Students ◽  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Health Concern ◽  
Small Data ◽  
Sectional Study ◽  
Cross Sectional ◽  
Study Population ◽  
National Defence

Background: Antimicrobial prescribing behaviors are often influenced by the local culture and prescribing appropriateness of medical doctors and other health care professionals. Globally, antimicrobial utilization practices have a profound impact on antimicrobial resistance and are a tremendous public health concern. The aim of this survey was to explore the knowledge and attitudes of medical students from the National Defence University of Malaysia regarding antimicrobial usage and antimicrobial resistance. Research design and methods: This was a cross-sectional study. The study population consisted of undergraduate medical students in each year group from the National Defence University of Malaysia. Students receive limited formal training on the use of antibiotics in their curriculum, and most of this learning is opportunistic whilst on clinical placement. Universal sampling was used as the study population was small. Data were collected utilizing a previously validated instrument regarding antibiotic use. Simple descriptive statistics were used to generate frequencies and percentages with SPSS V21. This research was approved by the Centre for Research and Innovation Management, National Defence University of Malaysia. Results: 206 questionnaires were distributed with a response rate of 99.03%, 54% (110) male, and 46% (94) female. Out of the respondents, 65% (132) had used antibiotics in the last year. Respondents displayed a moderate level of knowledge about antibiotics. Conclusions: This study revealed that the older the student was, or when the year of study and total knowledge score was higher, the students were less likely to stop antimicrobials when they felt better or use leftover antibiotics without consulting a doctor. Therefore, the nearer the students were to graduation, the better their knowledge and skills were, and this translated into their own behaviors regarding use of antimicrobials. This finding has clear implications for curriculum design and the inclusion of formal teaching throughout the medical program on antimicrobial use and antimicrobial resistance (AMR). However, more research is needed on this topic, including the prescribing habits and antibiotic use of practicing doctors.

scholarly journals Acute malnutrition and its determinants of preschool children in Bangladesh: gender differentiation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Md. Reazul Karim ◽  
Abu Sayed Md. Al Mamun ◽  
Md. Masud Rana ◽  
Rashidul Alam Mahumud ◽  
Nurun Naher Shoma ◽  
...  
Keyword(s):  
Preschool Children ◽  
Associated Factors ◽  
Severe Acute Malnutrition ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Health Concern ◽  
Global Public Health ◽  
Cross Sectional ◽  
Modifiable Factors

Abstract Background Children acute malnutrition (AM) is a global public health concern, especially in low and middle income countries. AM is associated with multiple physiological vulnerabilities, including immune dysfunction, enteric barrier disruption, gut microbiome dysbiosis, and essential nutrient deficits. This study aimed to determine the prevalence of AM and its associated factors among preschool children in Rajshahi district, Bangladesh. Methods This cross-sectional study was conducted from October to December, 2016. Children acute malnutrition was assessed using mid-upper arm circumference. Multiple binary logistic regression analyses were employed to determine the associated factors after adjusting the effect of independent factors of children AM. Result The prevalence of AM amongst preschool children was 8.7%, among them 2.2 and 6.5% were severe acute malnutrition and moderate acute malnutrition, respectively. Z-proportional test demonstrated that the difference in AM between girls (11.6) and boys (5.9%) was significant (p < 0.05). Children AM was associated with being: (i) children aged 6–23 months (aOR = 2.29, 95% CI: 1.20–4.37; p < 0.05), (ii) early childbearing mothers’ (age < 20 years) children (aOR = 3.06, 95% CI: 1.08–8.66; p < 0.05), (iii) children living in poor family (aOR = 3.08, 95% CI: 1.11–8.12; p < 0.05), (iv) children living in unhygienic latrine households (aOR = 2.81, 95% CI: 1.52–5.09; p < 0.01), (v) Hindu or other religion children (aOR = 0.42, 95% CI: 0.19–0.92; p < 0.05). Conclusion The prevalence of AM was high among these preschool children. Some modifiable factors were associated with AM of preschool children. Interventions addressing social mobilization and food security could be an effective way to prevent acute malnutrition among children in Bangladesh.

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