scholarly journals Etiology of Infectious Diarrhea in Patients Tested for Clostridium difficile: If It Isn’t Clostridium difficile, What Is It?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S2-S2
Author(s):  
Jennie H Kwon ◽  
Tiffany Hink ◽  
Kimberly Reske ◽  
Erik R Dubberke ◽  
Carey-Ann D Burnham
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Agar Plate ◽  
Stool Culture ◽  
Blood Agar Plate ◽  
Care Hospital ◽  
E Coli ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Research Grant

Abstract Background The objective of the study was to assay for alternative infectious causes of diarrhea in patients with negative EIA tests for Clostridium difficile. Methods A hard-stop alert was implemented at a tertiary care hospital to limit repeat testing for C. difficile within 96 hours of an initial negative EIA. Stool samples from patients with a negative (–) repeat EIA test for C. difficile within 96 hours in the 3 months pre- and postintervention underwent further evaluation: C. difficile toxigenic culture, GeneXpert C. difficile PCR, Biofire Gastrointestinal (GI) Panel, and culture on a blood agar plate. Results Of the 84 C. difficile EIA stool specimens evaluated, 8% were toxigenic culture positive (+), 8% tested + for C. difficile via the Biofire GI panel, and 5 (7%) + with the GenXpert C. difficile PCR (Table 1). Three of these patients were diagnosed with CDI within 30 days of a + test. Five patients were + for Norovirus via Biofire GI panel; none were tested for or diagnosed with Norovirus. Two patients were + for Enteropathogenic E. coli and one for Enteroaggregative E. coli via Biofire GI panel; none were tested for or diagnosed with E. coli infection. One patient was positive for Salmonella and Salmonella was isolated by stool culture. Conclusion Patients tested for C. difficile may have alternate causes of diarrhea. When evaluating hospitalized patients with diarrhea, C. difficile, along with alternate causes of diarrhea can be considered. Disclosures E. R. Dubberke, Merck: Consultant, Consulting fee; Biofire: one time talk, Speaker honorarium;; Alere: one-time talk, Speaker honorarium; Sanofi pasteur: Grant Investigator, Grant recipient; Pfizer: Consultant, Consulting fee; Rebiotix: Investigator, Research support; Rebiotix: Consultant, Consulting fee; valneva: Consultant, Consulting fee; C. A. D. Burnham, bioMerieux: Grant Investigator, Research grant; ThermoFisher: Consultant, Salary; Cepheid: Grant Investigator, Research grant

scholarly journals Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

2018 ◽  
Vol 39 (11) ◽  
pp. 1330-1333 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
Candice Cass ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Patient Population ◽  
Tertiary Care ◽  
Clinical Microbiology Laboratory ◽  
Care Hospital ◽  
Toxigenic Culture ◽  
Stool Samples ◽  
Stool Specimens ◽  
Clinically Significant ◽  
Culture Negative

AbstractObjectiveTo determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing.DesignRetrospective cohort.SettingTertiary-care hospital in St. Louis, Missouri.PatientsPatients whose diarrheal stool samples were submitted to the hospital’s clinical microbiology laboratory for C. difficile testing (toxin EIA) from August 2014 to September 2016.InterventionsElectronic and manual chart review were used to determine whether patients tested for C. difficile toxin had clinically significant diarrhea and/or any alternate cause for diarrhea. Toxigenic C. difficile culture was performed on all stool specimens from patients with clinically significant diarrhea and no known alternate cause for their diarrhea.ResultsA total of 8,931 patients with stool specimens submitted were evaluated: 570 stool specimens were EIA positive (+) and 8,361 stool specimens were EIA negative (−). Among the EIA+stool specimens, 107 (19% of total) were deemed eligible for culture. Among the EIA− stool specimens, 515 (6%) were eligible for culture. One EIA+stool specimen (1%) was toxigenic culture negative. Among the EIA− stool specimens that underwent culture, toxigenic C. difficile was isolated from 63 (12%).ConclusionsMost patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA− patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

scholarly journals Effectiveness of a Two-Step Testing Algorithm for Reliable and Cost-Effective Detection of Clostridium difficile Infection in a Tertiary Care Hospital in Saudi Arabia

2019 ◽  
Vol 7 (1) ◽  
pp. 6
Author(s):  
Mohammed Qutub ◽  
Prasanth Govindan ◽  
Anupama Vattappillil
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Tertiary Care ◽  
Care Hospital ◽  
Predictive Values ◽  
Stool Samples ◽  
Step Algorithm ◽  
Testing Algorithm ◽  
Sensitivity Specificity ◽  
Pcr Test

The aim of this study was to evaluate the effectiveness of a two-step algorithm for the detection of Clostridium difficile infection. Setting and Design: A two-step testing algorithm was evaluated for testing stool samples from patients suspected of Clostridium difficile infection (CDI). A total of 103 stool specimens were tested using the C. diff Quik Chek Complete enzyme immunoassay (EIA) test and the Xpert C. difficile PCR test. A two-step algorithm was implemented, and data from 3518 patient samples tested during a two-year period after implementation were analyzed to evaluate the effectiveness. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of the Quik Chek Complete EIA test were calculated using the Xpert C. difficile PCR test as a reference method. The sensitivity, specificity, PPV, and NPV of the Quik Chek Complete EIA test for C. difficile toxin were 46.7%, 100%, 100%, and 91%, respectively. The two-step algorithm, which combined the Quik Chek Complete EIA with Xpert C. difficile PCR, improved the sensitivity and also provided rapid detection. When algorithm-based testing was performed daily, there was a 66% reduction in turnaround time compared to batch testing using a lengthy ELISA procedure. Postimplementation data analysis showed that almost 89% of the samples could be reported immediately by initial screening with Quik Chek Complete EIA. Only 11% of the samples gave discrepant results and required PCR confirmation. According to our results, the two-step algorithm is an effective tool for the rapid and reliable detection of toxigenic C. difficile from stool samples.

scholarly journals Etiology of bacterial and parasitological pediatric diarrhoea in a tertiary care hospital

2016 ◽  
Vol 7 (3) ◽  
pp. 54-57
Author(s):  
Animesh Panda ◽  
Shiv Kumar Chandrakar ◽  
Smita Bawankar ◽  
Dhruba Hari Chandi
Keyword(s):  
Giardia Lamblia ◽  
Bacterial Infections ◽  
Tertiary Care ◽  
Central Research Institute ◽  
Central Research ◽  
Care Hospital ◽  
Medical Sciences ◽  
E Coli ◽  
Pathogenic Escherichia Coli ◽  
Stool Samples

Background : Before starting to discuss about Diarrhoea, we have to remember diarrhoea is one of the main causes of morbidity and mortality in children. Aims and Objectives : The aim of this study was to determine the prevalence of intestinal parasitic and bacterial infections as cause of childhood diarrhoea. Materials and Methods : During the study period, a total of 116 stool samples were collected and processed. Examined grossly and microscopically for presence of ova/cyst. They were also cultured on MacConkey agar and E. coli isolated were identified by standard biochemical tests.Results : Out of 116 stools samples, Entamoeba histolytica (63.33%) and Giardia lamblia (23.33%) were more common parasitic cause diarrhoea among children by either ova or cyst. E.coli (74.13%) was common bacterial cause of diarrhoea among children. E. coli isolated in pure culture and sent for sero typing to Central Research Institute (CRI), Kasauli. Maximum percent were found to be pathogenic Escherichia coli i.e. EPEC 22.5%. Conclusion :  According to the result, the most common cause of bacterial diarrhoea is E.coli. EPEC were more prevalent followed by EHEC. Thus, macroscopic and microscopic stool examinations as well as culture were important for finding out the course of diarrhoea in childhood.Asian Journal of Medical Sciences Vol. 7(3) 2016 54-57

scholarly journals Searching for a Potential Algorithm for Clostridium difficile Testing at a Tertiary Care Hospital: Does Toxin Enzyme Immunoassay Testing Help?

2018 ◽  
Vol 56 (7) ◽  
pp. e00415-18
Author(s):  
Angela M. Theiss ◽  
Agnes Balla ◽  
Angie Ross ◽  
Denise Francis ◽  
Christina Wojewoda
Keyword(s):  
Clostridium Difficile ◽  
Clinical Management ◽  
Tertiary Care ◽  
Laboratory Data ◽  
The United States ◽  
Care Hospital ◽  
Content Type ◽  
Molecular Tests ◽  
Stool Samples ◽  
Testing Algorithm

ABSTRACT Clostridium difficile is a major contributor to morbidity and mortality in the United States. Methods for identifying the organism in stool include molecular platforms, enzyme immunoassays (EIAs) for toxin, and culture. Controversy persists over whether molecular tests are too sensitive at identifying C. difficile, and there are questions about how additional laboratory information could inform clinical management and reduce over treatment. The aim of this study was to assess whether clinical factors are related to the toxin status of patients and whether information about toxin status could potentially inform clinical management of patients. A total of 201 PCR-positive C. difficile stool samples from adult patients at our institution underwent EIA toxin testing. Clinical and laboratory data were collected, and the percentage of PCR-positive/EIA-positive (PCR+/EIA+) patients and PCR+ and EIA-negative (PCR+/EIA−) patients was calculated. Of the 201 samples, 47% were EIA positive and 53% were EIA negative. Although PCR+/EIA+ patients were more likely to have had a prior C. difficile infection (P = 0.015), there was no statistical difference between the additional data collected that correlated with a positive EIA result. We were unable to show that patients with an EIA+ result had worse clinical parameters than those with EIA− results and concluded that establishing a testing algorithm that included both PCR and EIA testing would not change the clinical management of patients at our hospital.

scholarly journals Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients

2015 ◽  
Vol 59 (8) ◽  
pp. 4533-4543 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Sondra Seiler ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Content Acquisition ◽  
Stool Samples

ABSTRACTAsymptomatic colonization may contribute toClostridium difficiletransmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study ofC. difficilecolonization and risk factors forC. difficileacquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics,C. difficileinfection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured forC. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized withC. difficile(toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated withC. difficileacquisition (47% of patients who acquiredC. difficileversus 25% of patients who did not;P= 0.03). β-lactam–β-lactamase inhibitor combinations were associated with a loss ofC. difficilecolonization (36% of patients who lostC. difficilecolonization versus 8% of patients colonized at both admission and discharge;P= 0.04), as was metronidazole (27% versus 3%;P= 0.03). Antibiotic use affects the epidemiology of asymptomaticC. difficilecolonization, including acquisition and loss, and it requires additional study.

scholarly journals The prevalence of the iutA and ibeA genes in Escherichia coli isolates from severe and non-severe patients with bacteremic acute biliary tract infection is significantly different

Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mahoko Ikeda ◽  
Tatsuya Kobayashi ◽  
Fumie Fujimoto ◽  
Yuta Okada ◽  
Yoshimi Higurashi ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Tract Infection ◽  
Biliary Tract ◽  
Iron Acquisition ◽  
Tertiary Care ◽  
Care Hospital ◽  
Biliary Tract Infection ◽  
E Coli ◽  
Severe Group ◽  
Tract Infections

Abstract Background Although Escherichia coli is the most frequently isolated microorganism in acute biliary tract infections with bacteremia, data regarding its virulence are limited. Results Information on cases of bacteremia in acute biliary tract infection in a retrospective study was collected from 2013 to 2015 at a tertiary care hospital in Japan. Factors related to the severity of infection were investigated, including patient background, phylogenetic typing, and virulence factors of E. coli, such as adhesion, invasion, toxins, and iron acquisition. In total, 72 E. coli strains were identified in 71 cases, most of which primarily belonged to the B2 phylogroup (68.1%). The presence of the iutA gene (77.3% in the non-severe group, 46.4% in the severe group, P = 0.011) and the ibeA gene (9.1% in the non-severe group, and 35.7% in the severe group, P = 0.012) was significantly associated with the severity of infection. Among the patient characteristics, diabetes mellitus with organ involvement and alkaline phosphatase were different in the severe and non-severe groups. Conclusions We showed that bacteremic E. coli strains from acute biliary tract infections belonged to the virulent (B2) phylogroup. The prevalence of the iutA and ibeA genes between the two groups of bacteremia severity was significantly different.

scholarly journals Asymptomatic Bacteriuria among Pregnant Women Attending Tertiary Care Hospital in Lucknow, India

2021 ◽  
pp. 1-8
Author(s):  
Naimshree Sonkar ◽  
Malay Banerjee ◽  
Suman Gupta ◽  
Absar Ahmad
Keyword(s):  
Haemoglobin Level ◽  
Pregnant Women ◽  
Antimicrobial Susceptibility ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Care Hospital ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli

Introduction: Asymptomatic bacteriuria (ASB) is the presence of actively multiplying bacteria within the urinary tract with absence of any symptoms, resulting in adverse pregnancy outcomes. This research study was done in order to review prevalence, antimicrobial susceptibility profile, and factors associated with ASB occurring in female patients who are pregnant and being treated at a tertiary care hospital in Lucknow, India. Method and Materials: This is a cross-sectional study done among 216 pregnant women attending a hospital for antenatal check-ups. Clean catch midstream urine samples were collected and examined microscopically, and semi-quantitative culture was done on blood agar and MacConkey agar. Isolates were identified by colony morphology and biochemical tests, and antimicrobial susceptibility testing was done by using the Kirby-Bauer method. Results: Of the 216 pregnant women, 36 (16.7%) tested positive for ASB. The female gestational period, haemoglobin level, and BMI were significantly associated with ASB. Logistic regression also showed that higher haemoglobin level was less likely to ASB (AOR = 0.42, 95% confidence interval: 0.202–0.88, p = 0.021). The predominant and usual isolates were E. coli (n = 22, 61.1%), followed by Cons (n = 6, 16.7%), and S. aureus (3, 8.3%). All Gram-negative isolates were mostly sensitive to most of the drugs like piperacillin-tazobactam, cefepime, nitrofurantoin, and meropenem but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to ampicillin, vancomycin, linezolid, and nitrofurantoin but 100% resistant to co-trimoxazole. Conclusion: The present study shows the existence of ASB was 16.7% among women who are pregnant. Pregnancy duration, haemoglobin level, and BMI were significantly associated with ASB. The isolates identified more frequently were E. coli (61.16%), Cons (16.7%), and S. aureus (8.3%). All isolates which were Gram-negative were mostly sensitive to most of the drugs but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to most of the drugs but 100% resistant to co-trimoxazole.

Rising Economic Impact of Clostridium difficile-Associated Disease in Adult Hospitalized Patient Population

2008 ◽  
Vol 29 (9) ◽  
pp. 823-828 ◽  
Author(s):  
Xiaoyan Song ◽  
John G Bartlett ◽  
Kathleen Speck ◽  
April Naegeli ◽  
Karen Carroll ◽  
...  
Keyword(s):  
At Risk ◽  
Mortality Rate ◽  
Clostridium Difficile ◽  
Economic Burden ◽  
Excess Mortality ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Adult Patients ◽  
Care Hospital ◽  
Course Of Illness

Background.Clostridium difficile-associated disease (CDAD) is responsible for increased morbidity and a substantial economic burden. Incidences of CDAD, including those with a severe course of illness, have been increasing rapidly.Objective.To evaluate the excess mortality, increased length of stay (LOS) in the hospital, and additional costs associated with CDAD.Design.A retrospective matched cohort study.Patients.Adult patients admitted to a large tertiary care hospital between January 2000 and October 2005.Methods.Adult patients were tested with a C. difficile laboratory assay at admission or 72 hours after admission. Infected patients had lor more positive assay results and were individually matched to 1 uninfected patient who had negative assay results, by exposure time, age, ward, and at least 2 measurements for comorbidity and severity of illness.Results.The incidence rate of CDAD among adult patients increased from 0.57 cases per 1,000 patient-days at risk before 2004 to 0.88 cases per 1,000 patient-days at risk after 2004 (P < .001). The 630 infected patients had a mortality rate of 11.9%; the 630 uninfected patients had a mortality rate of 15.1% (P = .02). After adjustment in the multivariate analysis, we found that the LOS for infected patients was 4 days longer than that for uninfected patients (P < .001). If CDAD occurred after 2004, the additional LOS increased to 5.5 days. The direct cost associated with CDAD was $306 per case; after year 2004, it increased to $6,326 per case.Conclusions.There may be no excess mortality among patients with CDAD, compared with patients without it, but the economic burden of CDAD is increasing. By 2004, CDAD-associated medical expenditures approached $1,000,000 per year at our institution alone.

Sign in / Sign up

Export Citation Format

Share Document