scholarly journals Risk factors and intestinal microbiota: Clostridioides difficile infection in patients receiving enteral nutrition at Intensive Care Units

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Daosheng Wang ◽  
Danfeng Dong ◽  
Chen Wang ◽  
Yingchao Cui ◽  
Cen Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Intensive Care Units ◽  
Intestinal Microbiota ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals Risk factors and Intestinal Microbiota: Clostridioides difficile Infection in Patients Receiving Enteral Nutrition at Intensive Care Unit

2020 ◽  
Author(s):  
Daosheng Wang ◽  
Danfeng Dong ◽  
Chen Wang ◽  
Yingchao Cui ◽  
Cen Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Intestinal Microbiota ◽  
Intestinal Microbiome ◽  
Clostridioides Difficile ◽  
Nosocomial Diarrhea ◽  
Clostridioides Difficile Infection ◽  
Clinical Records

Abstract Background: Clostridioides difficile infection (CDI) is a leading cause of nosocomial diarrhea. Patients receiving enteral nutrition (EN) in the intensive care unit (ICU) are potentially at high risk of CDI. Presently, we assessed the risk factors and intestinal microbiome of these patients to better understand the occurrence and development of CDI. Methods: Patients were screened for C. difficile every week after EN started and their clinical records were collected for risk factor identification. Feces were analyzed for 16S rRNA sequencing to evaluate the intestinal microbiota. Results : Overall incidence of CDI was 10.7% (18/168 patients). History of cerebral infarction was associated with CDI occurrence (OR, 9.759; 95% CI, 2.140-44.498) and treatment with metronidazole could be protective (OR, 0.287; 95% CI, 0.091-0.902). Patients with EN had lower microbial richness and diversity, accompanied by reduced abundance of Bacteroides , Prevotella_9, Ruminococcaceae and Lachnospiraceae. Of these patients, acquisition of C. difficile resulted in a transient increase in microbial diversity, along with consistent alterations in the proportion of some bacterial taxa, especially Ruminococcaceae and Lachnospiraceae. At the initiation of EN, patients who were positive for C. difficile later had enhanced abundance of Bacteroides , which was negatively correlated with C. difficile load when CDI developed. Conclusion : ICU patients receiving EN had a high prevalence of CDI, and a fragile intestinal microbial environment. Alteration of microbiota composition could be vital in the process of CDI development, bringing new insights in the interaction between C. difficile and host microbiome.

scholarly journals Risk factors for Clostridioides difficile infection and colonization among patients admitted to intensive care units  in Shanghai, China

2019 ◽  
Author(s):  
Yingchao Cui ◽  
Danfeng Dong ◽  
Lihua Zhang ◽  
Daosheng Wang ◽  
Cen Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Protective Factor ◽  
Epidemic Clone ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Hospital Stays ◽  
And Control ◽  
Epidemiological Characteristics

Abstract Background : Clostridioides difficile is considered to be the main pathogen responsible for hospital-acquired infections. This study performed a prospective study to describe the prevalence, molecular epidemiological characteristics and risk factors of Clostridioides difficile infection (CDI) and Clostridioides difficile colonization (CDC) among patients in intensive care units (ICUs), a tertiary hospital in China, with the aim of providing strategies for efficient CD prevention and control. Methods: Stool samples were collected and anaerobically cultured for C. difficile . The identified isolates were tested for toxin genes and multi-locus sequence typing. The medical records of patients who were divided into CDI, CDC and control groups were collected and analyzed to investigate the risk factors. Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) patients were identified with CDI and CDC, respectively. An association was found between CDI patients and having a fever (OR=13.993) or metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or a combination of antibiotics (OR=2.856). CDC patients were characterized by longer hospital stays (OR=1.137), an increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043) and treatment with vancomycin (OR=18.168). Significantly, treatment with metronidazole was simultaneously found to be a protective factor in the two groups (OR=0.042; OR=0.013). Eighteen sequence types (STs) were identified. Among the CDI group, the isolates were predominantly toxin A and toxin B positive (A+B+) strains and genotype ST2 was the epidemic clone. In the CDC group, the dominant strains were A+B+ and ST81 was the epidemic clone. Conclusions: The prevalence of CDC and CDI in our ICUs was relatively high, suggesting the importance of routine screening to detect the acquisition of this pathogen. Future prevention and treatment strategies for C. difficile -related disease should consider hospital stays, enteral nutrition, underlying comorbidities, and the use of combined antibiotics. Moreover, metronidazole could be a protective factor for both CDI and CDC, which could be used empirically .

Certain Rooms in Intensive Care Units May Harbor Risk for Clostridioides difficile Infection

2022 ◽  
Author(s):  
Sarah Danehower ◽  
Jared Lazorko ◽  
Lewis J. Kaplan ◽  
Mark Fegley ◽  
Juliane Jablonski ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals Risk factors for development of initial Clostridioides difficile infection

2021 ◽  
Vol 25 ◽  
pp. 18-22
Author(s):  
Jamie L. Wagner ◽  
Kayla R. Stover ◽  
Allison M. Bell ◽  
Katie E. Barber
Keyword(s):  
Risk Factors ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study

2018 ◽  
Vol 57 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Ferhat Arslan ◽  
Hulya Caskurlu ◽  
Sema Sarı ◽  
Hayriye Cankar Dal ◽  
Sema Turan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Control Study ◽  
Absolute Risk ◽  
Subsequent Development ◽  
Bloodstream Infections ◽  
Case Control ◽  
Prior Exposure ◽  
Control Study

Abstract Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56–3.14); prior exposure to N-acetylcysteine, 0.11 (0.03–0.34) and prior surgical intervention, 1.26 (0.76–2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

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