scholarly journals Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Brandon J. Webb ◽  
Aruna Subramanian ◽  
Bert Lopansri ◽  
Bruce Goodman ◽  
Peter Bjorn Jones ◽  
...  
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Content Type ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Intermountain Healthcare ◽  
Health Care Associated Infection

ABSTRACT Clostridioides difficile infection (CDI) is a health care-associated infection associated with significant morbidity and cost, with highly varied risk across populations. More effective, risk-based prevention strategies are needed. Here, we investigate risk factors for hospital-associated CDI in a large integrated health system. In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (i) hospital-onset and (ii) health care-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including that of specific agents, using multivariable logistic regression. A total of 2,356 cases of CDI among 506,068 admissions were identified (incidence, 46.6 per 10,000). Prior antibiotic use was the dominant risk factor, where for every antibiotic day of therapy prior to the index admission, the odds of subsequent CDI increased by 12.8% (95% confidence interval [CI], 12.2 to 13.4%; P < 0.0001). This was a much stronger association than was inpatient antibiotic exposure (odds ratio [OR], 1.007 [95% CI, 1.005 to 1.009]; P < 0.0001). The highest-risk antibiotics included second-generation and later cephalosporins (especially oral), carbapenems, fluoroquinolones, and clindamycin, while doxycycline and daptomycin were associated with a lower CDI risk. We concluded that cumulative antibiotic exposure prior to admission is the greatest contributor to the risk of subsequent CDI. Most classes of antibiotics carry some risk, which varies by drug and route. This information may be useful for antimicrobial stewardship efforts.

scholarly journals Gut microbiota composition in health-care facility-and community-onset diarrheic patients with Clostridioides difficile infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giovanny Herrera ◽  
Laura Vega ◽  
Manuel Alfonso Patarroyo ◽  
Juan David Ramírez ◽  
Marina Muñoz
Keyword(s):  
Health Care ◽  
Gut Microbiota ◽  
Care Facility ◽  
Health Care Facility ◽  
Influential Factors ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
The Impact ◽  
Positive Groups ◽  
Community Onset

AbstractThe role of gut microbiota in the establishment and development of Clostridioides difficile infection (CDI) has been widely discussed. Studies showed the impact of CDI on bacterial communities and the importance of some genera and species in recovering from and preventing infection. However, most studies have overlooked important components of the intestinal ecosystem, such as eukaryotes and archaea. We investigated the bacterial, archaea, and eukaryotic intestinal microbiota of patients with health-care-facility- or community-onset (HCFO and CO, respectively) diarrhea who were positive or negative for CDI. The CDI-positive groups (CO/+, HCFO/+) showed an increase in microorganisms belonging to Bacteroidetes, Firmicutes, Proteobacteria, Ascomycota, and Opalinata compared with the CDI-negative groups (CO/−, HCFO/−). Patients with intrahospital-acquired diarrhea (HCFO/+, HCFO/−) showed a marked decrease in bacteria beneficial to the intestine, and there was evidence of increased Archaea and Candida and Malassezia species compared with the CO groups (CO/+, CO/−). Characteristic microbiota biomarkers were established for each group. Finally, correlations between bacteria and eukaryotes indicated interactions among the different kingdoms making up the intestinal ecosystem. We showed the impact of CDI on microbiota and how it varies with where the infection is acquired, being intrahospital-acquired diarrhea one of the most influential factors in the modulation of bacterial, archaea, and eukaryotic populations. We also highlight interactions between the different kingdoms of the intestinal ecosystem, which need to be evaluated to improve our understanding of CDI pathophysiology.

scholarly journals Pet Ownership Protects Against Recurrence of Clostridioides difficile Infection

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Laurel E Redding ◽  
Brendan J Kelly ◽  
Darko Stefanovski ◽  
John K Lautenbach ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Costs ◽  
Care Facility ◽  
Health Care Facility ◽  
Food Allergies ◽  
Pet Ownership ◽  
Clostridioides Difficile ◽  
Point Increase ◽  
Clostridioides Difficile Infection ◽  
Control Study

Abstract Background Clostridioides difficile infection (CDI) is the leading cause of antibiotic-associated and health care–associated diarrhea in humans. Recurrent CDI (R-CDI) occurs in ~20%–30% of patients with CDI and results in increased morbidity, mortality, and hospital costs. Genomic analyses have shown overlap of C. difficile isolates from animals and people, suggesting that a zoonotic reservoir may contribute to recurrence. The objective of this study was to determine whether pet ownership is a risk factor for recurrence of CDI. Methods We conducted a case–control study among patients with recurrent CDI (cases; n = 86) and patients with nonrecurrent CDI (controls; n = 146). Multivariable logistic regression modeling was used to determine the association between recurrence of CDI and pet ownership while accounting for patient-level risk factors. Results Pet ownership was not significantly associated with recurrence of CDI (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.38–2.72; P = 0.965) among all patients (n = 232). However, among the subset of patients with community-associated or community-onset health care facility–acquired CDI (n = 127), increasing contact with pets was increasingly protective against recurrence: for every point increase in a pet contact score (out of 7 possible points), the odds of recurrence decreased by 14% (OR, 0.86; 95% CI, 0.74–1.00; P = 0.051). Conclusions Close interactions with pets appear protective against the recurrence of community-acquired CDI. A potential mechanism may involve beneficial contributions to the microbiota of pet owners afflicted with CDI, as has been observed for other conditions such as atopy, obesity, and food allergies. However, more research is needed to understand the interactions between pets, owners, and their microbiota.

scholarly journals Evaluation of Cycle Threshold, Toxin Concentration, and Clinical Characteristics of Clostridioides difficile Infection in Patients with Discordant Diagnostic Test Results

2020 ◽  
Vol 58 (5) ◽  
Author(s):  
Megan D. Shah ◽  
Joan-Miquel Balada-Llasat ◽  
Kelci Coe ◽  
Erica Reed ◽  
Johanna Sandlund ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Laboratory Data ◽  
Antibiotic Use ◽  
Neutralization Assay ◽  
Test Results ◽  
Toxin Concentration ◽  
Content Type ◽  
Cycle Threshold ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

ABSTRACT Clostridioides difficile infection (CDI) is one of the most common health care-associated infections that can cause significant morbidity and mortality. CDI diagnosis involves laboratory testing in conjunction with clinical assessment. The objective of this study was to assess the performance of various C. difficile tests and to compare clinical characteristics, Xpert C. difficile/Epi (PCR) cycle threshold (CT), and Singulex Clarity C. diff toxins A/B (Clarity) concentrations between groups with discordant test results. Unformed stool specimens from 200 hospitalized adults (100 PCR positive and 100 negative) were tested by cell cytotoxicity neutralization assay (CCNA), C. diff Quik Chek Complete (Quik Chek), Premier Toxins A and B, and Clarity. Clinical data, including CDI severity and CDI risk factors, were compared between discordant test results. Compared to CCNA, PCR had the highest sensitivity at 100% and Quik Chek had the highest specificity at 100%. Among clinical and laboratory data studied, prevalences of leukocytosis, prior antibiotic use, and hospitalizations were consistently higher across all subgroups in comparisons of toxin-positive to toxin-negative patients. Among PCR-positive samples, the median CT was lower in toxin-positive samples than in toxin-negative samples; however, CT ranges overlapped. Among Clarity-positive samples, the quantitative toxin concentration was significantly higher in toxin-positive samples than in toxin-negative samples as determined by CCNA and Quik Chek Toxin A and B. Laboratory tests for CDI vary in sensitivity and specificity. The quantitative toxin concentration may offer value in guiding CDI diagnosis and treatment. The presence of leukocytosis, prior antibiotic use, and previous hospitalizations may assist with CDI diagnosis, while other clinical parameters may not be consistently reliable.

Expert-based approach to rank critical asset assessment factors for healthcare facilities

Facilities ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Dalia Salem ◽  
Emad Elwakil
Keyword(s):  
Health Care ◽  
Asset Management ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Assessment Model ◽  
Loss Assessment ◽  
Content Type ◽  
Care Facilities ◽  
General Safety

Purpose This research’s main objective is to develop an expert-based approach to rank critical asset assessment factors for health-care facilities. This approach will improve the asset management of health-care buildings. This paper aims to study and prioritize the relative importance of asset criticality factors. Design/methodology/approach The research methodology begins with a comprehensive literature review of state-of-the-art health-care facilities management, asset management tools, critical asset assessment and approaches to model techniques. Then, using the expert-based opinion and the collected data through the analytical hierarchy process approach to developing the asset assessment model contains physical, environmental, general safety and revenue loss assessment models. Findings Results showed that the general safety factors and the sub-factors of life safety and physical safety contributed to asset condition assessment. Practical implications The proposed critical asset assessment ranking will benefit health-care facility organizations by assessing their asset performance according to capital renewal needs. Originality/value This study offers a novel conceptual framework to understand and determine rank critical asset assessment factors for health-care facilities.

Factors affecting health tourism and international health-care facility choice

2017 ◽  
Vol 11 (1) ◽  
pp. 16-36 ◽  
Author(s):  
Gökhan Aydin ◽  
Bilge Karamehmet
Keyword(s):  
Health Care ◽  
Decision Process ◽  
International Health ◽  
Care Facility ◽  
Health Care Facility ◽  
Consumer Decision ◽  
Content Type ◽  
Factors Affecting ◽  
Consumer Decision Process ◽  
International Health Care

Purpose Health-care tourism has become a major industry in the past decade. Following the increasing activity in health-care tourism, the decision-making process of consumers in choosing an international health-care facility has become increasingly important to the related parties. The present study aims to offer a holistic model of international health-care facility choice that incorporates the important dimensions by assessing the growth drivers and the alternative factors proposed in the literature and by validating them via a survey study. Design/methodology/approach The factors deemed important in the existing literature were used as the basis of a study in Turkey. In total, 65 structured interviews were conducted with health-care professionals and international health tourists to understand the perspective of the two important parties that affect policymaking. Findings The findings of the study support the significance of the majority of the variables proposed as important factors affecting international health-care facility choice. Research limitations/implications The study was carried out in four large hospital chains in Turkey; however, this creates a limitation in scope and may have limited representativeness of the overall market. The model has yet to be tested on a larger scale. Practical implications There are significant differences in the opinions of professionals and international health-care tourists in terms of choice criteria. This indicates problems with health professionals’ understanding of the consumer decision process. Originality/value The study provides a model that can be used to gain insights on the consumer decision process and also provides the policymakers and stakeholders of the international health-care industry with a sound theoretical foundation to build further studies upon. Only a limited number of studies was carried out in Turkey that focus on international health-care tourism, and the present study will fill a substantial research gap.

scholarly journals The Emergency Medical Service Microbiome

2017 ◽  
Vol 84 (5) ◽  
Author(s):  
Andrew J. Hudson ◽  
Graeme D. Glaister ◽  
Hans-Joachim Wieden
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
The United States ◽  
Pathogen Transmission ◽  
Health Care Facilities ◽  
Content Type ◽  
Sequencing Technologies ◽  
Emergency Medical ◽  
Care Facilities

ABSTRACTEmergency medical services (EMS) personnel are an integral component of the health care framework and function to transport patients from various locations to and between care facilities. In addition to physical injury, EMS personnel are expected to be at high risk to acquire and transmit health care-associated infections (HAIs) in the workplace. However, currently, little is known about EMS biosafety risk factors and the epidemiological contribution of EMS to pathogen transmission within and outside the health care sector. Health care facility microbiomes contain diverse bacterial, fungal, and viral pathogens that cause over 1.7 million HAIs each year in the United States alone. While hospital microbiomes have been relatively well studied, there is scant information about EMS infrastructure and equipment microbiomes or the role(s) they play in HAI transmission between health care facilities. We review recent literature investigating the microbiome of ambulances and other EMS service facilities which consistently identify antibiotic-resistant pathogens causing HAIs, including methicillin-resistantStaphylococcus aureus(MRSA), vancomycin-resistantEnterococcus, andKlebsiella pneumoniae. Our review provides evidence that EMS microbiomes are dynamic and important pathogen reservoirs, and it underscores the need for more widespread and in-depth microbiome studies to elucidate patterns of pathogen transmission. We discuss emerging DNA sequencing technologies and other methods that can be applied to characterize and mitigate EMS biosafety risks in the future. Understanding the complex interplay between EMS and hospital microbiomes will provide key insights into pathogen transmission mechanisms and identify strategies to minimize HAIs and community infection.

Briefing practice and client satisfaction

Facilities ◽  
2017 ◽  
Vol 35 (1/2) ◽  
pp. 116-134 ◽  
Author(s):  
Abimbola Olukemi Windapo ◽  
Astrette Cloete
Keyword(s):  
South Africa ◽  
Health Care ◽  
Client Satisfaction ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Content Type ◽  
Care Facilities

Purpose This paper aims to examine briefing practices and whether these are related to the quality of brief documents and client satisfaction in constructed health-care facilities in South Africa. The rational for the examination stems from the view held by scholars that the briefing process is critical to the success of projects, as well as client/user satisfaction in the constructed facility, and also because of undocumented reports of client/end-user dissatisfaction in constructed health-care facilities in South Africa. Design/methodology/approach The research process consisted of a literature review to identify existing briefing framework and practices in use applicable to facilities. This was supported by an exploratory case study of a recently completed public hospital in East London, South Africa. Data collection for the study was undertaken by means of conducting semi-structured interviews with two groups consisting of client representatives and the technical design team on the project. Findings The research established that in the context of this case study, inadequate client consultation took place, not all design consultants were adequately involved in the development of the project brief, limited use was made of a specific briefing framework in developing the project brief and that despite these shortcomings in the briefing process followed, a comprehensive good quality briefing document was produced and the client was satisfied with the health-care facility constructed. Research limitations/implications The results of this study are generalizable with health-care facilities only. As such, research inferences and projections can only be made within this set and may not necessarily be applicable to the wider construction sector or to all projects within this sector. Practical implications The implications of this research are applicable to constructed health-care facilities. Practical inferences include the need to acknowledge that there is a need for a briefing framework, which should outline the involvement of all design consultants and client representatives when developing the project briefs for health-care facilities. The briefing framework is proposed for use in addressing the shortcomings in the briefing processes and practices and will also help the client in the choice of a brief process and practice which will comprehensively capture their requirements, give clear directives/information to the design consultants and will result in higher levels of end-user/patient satisfaction in the constructed health-care facility. Social implications Clients and allied professionals in charge of health-care facilities’ construction are encouraged to consider the implementation of a standard framework for use in the briefing process. This reflection should encourage engagement through formative legislative provision and transparent awareness campaigns. Originality/value This work is original insofar, as it directly addresses the alignment of briefing practices to quality of brief documents and client satisfaction in constructed health-care facilities within the context of the South African construction industry. However, similar exercises have been undertaken on briefing practices in the wider construction sector.

scholarly journals Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

2014 ◽  
Vol 58 (8) ◽  
pp. 4630-4635 ◽  
Author(s):  
Teena Chopra ◽  
Dror Marchaim ◽  
Paul C. Johnson ◽  
Reda A. Awali ◽  
Hardik Doshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Acinetobacter Baumannii ◽  
Bloodstream Infection ◽  
Medical Center ◽  
Care Facility ◽  
Health Care Facility ◽  
Positive Culture ◽  
Acinetobacter Calcoaceticus ◽  
Content Type

ABSTRACTIdentifying patients at risk for bloodstream infection (BSI) due toAcinetobacter baumannii-Acinetobacter calcoaceticuscomplex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥3 (odds ratio [OR], 2.34;P= 0.001), a direct admission from another health care facility (OR, 4.63;P< 0.0001), a prior hospitalization (OR, 3.11;P< 0.0001), the presence of an indwelling central venous line (OR, 2.75;P= 0.011), the receipt of total parenteral nutrition (OR, 21.2;P< 0.0001), the prior receipt of β-lactams (OR, 3.58;P< 0.0001), the prior receipt of carbapenems (OR, 3.18;P= 0.006), and the prior receipt of chemotherapy (OR, 15.42;P< 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40;P< 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

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