scholarly journals Are Patients with Prior Clostridium difficile Infection (CDI) a Potential Source of Transmission during Hospital Admissions?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S402-S402
Author(s):  
Melany Gonzalez-Orta ◽  
Carlos Saldana ◽  
Jennifer Cadnum ◽  
Curtis J Donskey
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Hospital Admissions ◽  
Prior History ◽  
Positive Skin ◽  
Potential Source ◽  
History Of ◽  
Time Of Admission

Abstract Background Many patients with Clostridium difficile infection (CDI) continue to shed spores asymptomatically after completion of CDI therapy. However, the duration of shedding and the potential for transmission during subsequent healthcare exposures is unknown. Methods During a 6-month period, we collected perirectal, groin, and skin (chest/abdomen and hands) cultures for toxigenic C. difficile from patients with a prior history of CDI who were admitted to the hospital. We calculated the frequencies of perirectal and skin shedding of C. difficile at the time of admission, stratified by the time since the prior CDI diagnosis. Results Of 28 patients with a prior history of CDI enrolled in the study, 10 (36%) had positive perirectal cultures for toxigenic C. difficile upon admission, and 6 of 10 (60%) had positive skin cultures. The figure shows the percentages of CDI cases with positive perirectal, groin, or skin cultures, stratified by the time since the prior CDI diagnosis. Conclusion Patients with prior CDI often shed spores asymptomatically during hospital admissions. Further studies are needed to determine whether these carriers contribute significantly to transmission. Disclosures All authors: No reported disclosures.

CSI: a severity index for Clostridium difficile infection at the time of admission

2011 ◽  
Vol 79 (2) ◽  
pp. 151-154 ◽  
Author(s):  
O.A. Lungulescu ◽  
W. Cao ◽  
E. Gatskevich ◽  
L. Tlhabano ◽  
J.G. Stratidis
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Severity Index ◽  
Time Of Admission

scholarly journals 2420. Reduced hospital-onset Clostridium difficile infection incidence following Saccharomyces boulardii co-administration with broad-spectrum antibiotics during hospitalization.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S835-S836
Author(s):  
Eric Wombwell ◽  
Mark E Patterson ◽  
Bridget Bransteitter ◽  
Lisa Gillen
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Hospital Admissions ◽  
Group Analysis ◽  
Probiotic Strain ◽  
Saccharomyces Boulardii ◽  
Protective Effects ◽  
Convenience Sample ◽  
Broad Spectrum Antibiotics

Abstract Background Conflicting evidence in smaller randomized trials and meta-analyses regarding the protective effects of probiotics against Clostridium difficile infection underscore the need for further study. Our objective was to evaluate the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on hospital-onset C. difficile (HO-CDI) rates within hospitalizations administered broad-spectrum antibiotics. Methods Retrospective cohort study merging hospital prescribing data with C. difficile case data from the National Health Safety Network at a 220-bed level-2 trauma center nonacademic hospital. A convenience sample of 8,763 hospital admissions administrated at least one dose of a fluoroquinolone, clindamycin, or β-lactam class antibiotic during hospitalization was assessed. Hospitalizations were categorized by whether antibiotics were administered alone (control) or in conjunction with S. boulardii 20 billion colony-forming units daily (intervention). Associations between S. boulardii administration and HO-CDI incidence was evaluated by multivariate logistic regression. A sub-group analysis evaluated the extent to which administering S. boulardii within or after 24-hours of antibiotic start changed the effect. Propensity scores incorporated to account for selection bias. Results Hospitalizations where S. boulardii was co-administered with antibiotics had a reduced likelihood of HO-CDI (OR = 0.56, 95% CI 0.32 – 0.93) compared with control hospitalizations. S. boulardii administered within 24-hours of antibiotic start had a reduced likelihood of HO-CDI (OR = 0.40, 95% CI 0.21 – 0.75). No effect observed if S. boulardii administered after 24-hours (OR = 0.86, 95% CI 0.45 – 1.64). Post-hoc analysis for disease latency, the average number of days to HO-CDI onset was 5.6, 6.4, and 8.0 days for antibiotic only, S. boulardii after 24-hours, and S. boulardii within 24-hours of antibiotic, respectively (P < 0.04). Conclusion Co-administering S. boulardii with broad-spectrum antibiotics is associated with a reduced risk of C. difficile in hospitalized patients, especially if started within 24-hours of antibiotic initiation. S. boulardii should be considered as preventative intervention to reduce the risk of HO-CDI. Disclosures All authors: No reported disclosures.

Relationship Between Remote History of Cholecystectomy and Risk for Incident Clostridium difficile Infection

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S94-S95
Author(s):  
Ying Wang ◽  
Jianhua Li ◽  
Philip Zachariah ◽  
Julian Abrams ◽  
Daniel E. Freedberg
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
History Of

scholarly journals 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S308-S308 ◽  
Author(s):  
Adam Pettigrew ◽  
Ripal Jariwala ◽  
Kristen Zeitler ◽  
Jose Montero ◽  
Sandra Gompf ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clostridium Difficile ◽  
Bloodstream Infection ◽  
Broad Spectrum ◽  
Case Series ◽  
Prior History ◽  
Broad Spectrum Antibiotics ◽  
History Of ◽  
Polymicrobial Bacteremia ◽  
Hospital Acquired

Abstract Background While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. Methods We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. Results Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. Conclusion CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. Disclosures All authors: No reported disclosures.

scholarly journals 500. Efficacy of 30-Day Fidaxomicin for Treatment of Acute Clostridium difficile Infection With History of Multiple Recurrences

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S185-S186 ◽  
Author(s):  
Christine Lee ◽  
Minahz Habib ◽  
Christiana Kim ◽  
Peyman Goldeh ◽  
Salaheddin Abouanaser ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
History Of ◽  
Multiple Recurrences

History of Cholecystectomy and Risk of Clostridium Difficile Infection

2020 ◽  
Author(s):  
Anqi Jin ◽  
Tony Chien ◽  
Qiwen Huang ◽  
Pragati Kenkare ◽  
Mai Vu ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
History Of

Routine Screening for Methicillin-ResistantStaphylococcus AureusAmong Patients Newly Admitted to an Acute Rehabilitation Unit

2002 ◽  
Vol 23 (9) ◽  
pp. 516-519 ◽  
Author(s):  
Farrin A. Manian ◽  
Diane Senkel ◽  
Jeanne Zack ◽  
Lynn Meyer
Keyword(s):  
Relative Yield ◽  
Prior History ◽  
Current Profile ◽  
Rehabilitation Unit ◽  
History Of ◽  
Mrsa Infection ◽  
Low Prevalence ◽  
Time Of Admission ◽  
Acute Rehabilitation ◽  
Mrsa Colonization

Background:Following an outbreak of methicillin-resistantStaphylococcus aureus(MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.Objectives:To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.Methods:Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit.Results:The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987–1988) to 12% (1999–2000) (P= .0009) for newly admitted patients and from 0% to 7% (P< .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.Conclusion:The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.

scholarly journals Respiratory Presentation of Pediatric Patients in the 2014 Enterovirus D68 Outbreak

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Georgina Martin ◽  
Rachel Li ◽  
Victoria E. Cook ◽  
Matthew Carwana ◽  
Peter Tilley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Hospital Admissions ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Respiratory Illness ◽  
Prior History ◽  
Medical Comorbidities ◽  
History Of ◽  
Enterovirus D68

Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children’s Hospital during the 2014 outbreak.Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors.Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P=0.03) and copathogens was associated with PICU admission (P=0.02).Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

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