Environmental and pharmaceutical risk factors for the transmission of Clostridium difficile and other multi-drug resistant hospital acquired infections

2019 ◽  
Author(s):  
Geneva Marion Wilson
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Drug Resistant ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

scholarly journals Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anastasia Saade ◽  
Giulia Moratelli ◽  
Guillaume Dumas ◽  
Asma Mabrouki ◽  
Jean-Jacques Tudesq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Cumulative Risk ◽  
Incidence Density ◽  
Hospital Acquired Infections ◽  
Underlying Malignancy ◽  
Single Center Study ◽  
High Prevalence ◽  
Immune Defect ◽  
Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

scholarly journals Molecular Epidemiology of Multi-Drug Resistant Pseudomonas aeruginosa Isolates from Hospitalized Patients in Greece

2020 ◽  
Vol 8 (11) ◽  
pp. 1652
Author(s):  
Olga Pappa ◽  
Anastasia Maria Kefala ◽  
Kyriaki Tryfinopoulou ◽  
Marios Dimitriou ◽  
Kostas Kostoulas ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Molecular Epidemiology ◽  
Financial Resources ◽  
Drug Resistant ◽  
Hospital Acquired Infections ◽  
Antimicrobial Sensitivity ◽  
Tertiary Hospitals ◽  
Hospital Acquired ◽  
First Time ◽  
Hospital Transmission

Resistant Pseudomonas aeruginosa isolates are one of the major causes of both hospital-acquired infections (HAIs) and community-acquired infections (CAIs). However, management of P. aeruginosa infections is difficult as the bacterium is inherently resistant to many antibiotics. In this study, a collection of 75 P. aeruginosa clinical isolates from two tertiary hospitals from Athens and Alexnadroupolis in Greece was studied to assess antimicrobial sensitivity and molecular epidemiology. All P. aeruginosa isolates were tested for susceptibility to 11 commonly used antibiotics, and the newly introduced Double Locus Sequence Typing (DLST) scheme was implemented to elucidate the predominant clones. The tested P. aeruginosa isolates presented various resistant phenotypes, with Verona Integron-Mediated Metallo-β-lactamase (VIM-2) mechanisms being the majority, and a new phenotype, FEPR-CAZS, being reported for the first time in Greek isolates. DLST revealed two predominant types, 32-39 and 8-37, and provided evidence for intra-hospital transmission of the 32-39 clone in one of the hospitals. The results indicate that DLST can be a valuable tool when local outbreaks demand immediate tracking investigation with limited time and financial resources.

scholarly journals New Role for Human α-Defensin 5 in the Fight against Hypervirulent Clostridium difficile Strains

2014 ◽  
Vol 83 (3) ◽  
pp. 986-995 ◽  
Author(s):  
Lucinda Furci ◽  
Rossella Baldan ◽  
Valentina Bianchini ◽  
Alberto Trovato ◽  
Cristina Ossi ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Gut Microbiota ◽  
Antimicrobial Activities ◽  
Content Type ◽  
Hospital Acquired Infections ◽  
Viability Assay ◽  
High Concentrations ◽  
Hospital Acquired ◽  
And Diffusion ◽  
Very High

Clostridium difficileinfection (CDI), one of the most common hospital-acquired infections, is increasing in incidence and severity with the emergence and diffusion of hypervirulent strains. CDI is precipitated by antibiotic treatment that destroys the equilibrium of the gut microbiota. Human α-defensin 5 (HD5), the most abundant enteric antimicrobial peptide, is a key regulator of gut microbiota homeostasis, yet it is still unknown ifC. difficile, which successfully evades killing by other host microbicidal peptides, is susceptible to HD5. We evaluated, by means of viability assay, fluorescence-activated cell sorter (FACS) analysis, and electron microscopy, the antimicrobial activities of α-defensins 1 and 5 against a panel ofC. difficilestrains encompassing the most prevalent epidemic and hypervirulent PCR ribotypes in Europe (012, 014/020, 106, 018, 027, and 078). Here we show that (i) concentrations of HD5 within the intestinal physiological range produced massiveC. difficilecell killing; (ii) HD5 bactericidal activity was mediated by membrane depolarization and bacterial fragmentation with a pattern of damage peculiar toC. difficilebacilli, compared to commensals likeEscherichia coliandEnterococcus faecalis; and (iii) unexpectedly, hypervirulent ribotypes were among the most susceptible to both defensins. These results support the notion that HD5, naturally present at very high concentrations in the mucosa of the small intestine, could indeed control the very early steps of CDI by killingC. difficilebacilli at their germination site. As a consequence, HD5 can be regarded as a good candidate for the containment of hypervirulentC. difficilestrains, and it could be exploited in the therapy of CDI and relapsingC. difficile-associated disease.

Risk factors for drug-resistant pathogens in patients with hospital-acquired and ventilator-associated pneumonia

2017 ◽  
Author(s):  
Masahiro Sano ◽  
Yuichiro Shindo ◽  
Junya Okumura ◽  
Toshihiro Sakakibara ◽  
Toshiaki Matsuda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Hospital Acquired

Incidence and Risk Factors for Community and Hospital Acquisition of Clostridium difficile Infection in the Tel Aviv Sourasky Medical Center

2017 ◽  
Vol 38 (8) ◽  
pp. 912-920 ◽  
Author(s):  
Wasef Na’amnih ◽  
Amos Adler ◽  
Tamar Miller-Roll ◽  
Dani Cohen ◽  
Yehuda Carmeli
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Confidence Interval ◽  
Family Member ◽  
Incidence Rate ◽  
Odds Ratio ◽  
Close Contact ◽  
Medical Center ◽  
Tel Aviv ◽  
Hospital Acquired

OBJECTIVESTo estimate the incidence and identified risk factors for community-acquired (CA) and hospital-acquired (HA) Clostridium difficile infection (CDI)METHODSWe conducted 2 parallel case-control studies at Tel Aviv Sourasky Medical Center from January 1, 2011, to December 31, 2014. We identified persons with CDI, determined whether infection was community or hospital acquired, and calculated incidence rates from 2007 to 2014. We collected demographic, clinical, and epidemiological information for CDI cases and hospitalized control cases and estimated the odds ratio with 95% confidence interval using conditional logistic regression.RESULTSIn total, 1,563 CDI cases were identified in the study. The incidence rate of CA-CDI and HA-CDI increased by 1.6-fold and 1.2-fold, respectively, during 2012–2014. However, the incidence rate of CA-CDI was 0.84 per 100,000 (95% CI, 0.52–1.30), the rate for HA-CDI was 4.7 per 10,000 patient days (95% CI, 4.08–5.38), respectively, in 2014. We identified several factors as independent variables significantly associated with HA-CDI: functional disability, presence of nasogastric tube, antibiotic use, chemotherapy, infection by extended-spectrum β-lactamases, and mean of albumin values. Risk factors independently associated with CA-CDI were close contact with a family member who had been hospitalized in the previous 6 months, inflammatory bowel disease, and home density index (adjusted odds ratio, 25.7; 95% confidence interval, 3.99–165.54; P=.001).CONCLUSIONSThe identification of the main modifiable risk factors for HA-CDI (antibiotic exposure and hypoalbuminemia) and for CA-CDI (close contact with a family member who had been hospitalized in the previous 6 months) is likely to optimize prevention efforts; these factors are critical in preventing the spread of CDI.Infect Control Hosp Epidemiol 2017;38:912–920

scholarly journals Postoperative Burden of Hospital-Acquired Clostridium difficile Infection

2015 ◽  
Vol 36 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Zaid M. Abdelsattar ◽  
Greta Krapohl ◽  
Layan Alrahmani ◽  
Mousumi Banerjee ◽  
Robert W. Krell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Lower Extremity ◽  
Bowel Resection ◽  
Hospital Acquired Infection ◽  
Incidence Risk ◽  
Multivariable Regression Models ◽  
Hospital Acquired ◽  
The Impact

OBJECTIVEClostridium difficile infection (CDI) is a common hospital-acquired infection. Previous reports on the incidence, risk factors, and impact of CDI on resources in the surgical population are limited. In this context, we study CDI across diverse surgical settings.METHODSWe prospectively identified patients with laboratory-confirmed postoperative CDI after 40 different general, vascular, or gynecologic surgeries at 52 academic and community hospitals between July 2012 and September 2013. We used multivariable regression models to identify CDI risk factors and to determine the impact of CDI on resource utilization.RESULTSOf 35,363 patients, 179 (0.51%) developed postoperative CDI. The highest rates of CDI occurred after lower-extremity amputation (2.6%), followed by bowel resection or repair (0.9%) and gastric or esophageal operations (0.7%). Gynecologic and endocrine operations had the lowest rates (0.1% and 0%, respectively). By multivariable analyses, older age, chronic immunosuppression, hypoalbuminemia (≤3.5 g/dL), and preoperative sepsis were associated with CDI. Use of prophylactic antibiotics was not independently associated with CDI, neither was sex, body mass index (BMI), surgical priority, weight loss, or comorbid conditions. Three procedure groups had higher odds of postoperative CDI: lower-extremity amputations (adjusted odds ratio [aOR], 3.5; P=.03), gastric or esophageal operations (aOR, 2.1; P=.04), and bowel resection or repair (aOR, 2; P=.04). Postoperative CDI was independently associated with increased length of stay (mean, 13.7 d vs 4.5 d), emergency department presentations (18.9 vs 9.1%) and readmissions (38.9% vs 7.2%, all P<.001).CONCLUSIONSIncidence of postoperative CDI varies by surgical procedure. Postoperative CDI is also associated with higher rates of extended length of stay, emergency room presentations, and readmissions, which places a potentially preventable burden on hospital resources.Infect Control Hosp Epidemiol 2015;36(1): 40–46

scholarly journals Clinical Characteristics in Patients with Hospital-Acquired Pneumonia Caused by Extensively Drug-Resistant Acinetobacter baumannii, A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Yujun Li ◽  
Xiaomei Huang ◽  
Yuyao Wang ◽  
Chuzhi Pan ◽  
Zexun Mo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Drug Resistant ◽  
Central Venous ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Lactamase Inhibitor

Abstract Background Extremely drug-resistant (XDR) Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

scholarly journals An effect of single high dose of vitamin D3 on the risk of nosocomial infections, hospitalization time and mortality in hospitalized elderly population. A preliminary report

2020 ◽  
Vol 2 (2) ◽  
pp. 1-5
Author(s):  
Dorota Leszczyńska ◽  
Agata Tuszyńska ◽  
Magdalena Zgliczyńska ◽  
Wojciech Zgliczyński ◽  
Waldemar Misiorowski
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Vitamin D3 ◽  
Nosocomial Infections ◽  
Control Group ◽  
High Dose ◽  
Single High Dose ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
The Impact

Introduction: Observational studies indicate a significant impact of serum 25(OH)D concentration on incidence of hospital-acquired infections. However, we did not find any interventional study assessing the effect of vitamin D3 administration at the admission on the course of further hospitalization in internal medicine departments. Objective of the paper: Investigation of the impact of one-time high-dose vitamin D3 administration in elderly patients on the day of urgent admission to the hospital, on hospital-acquired infections. Materials and methods: A randomized, two-arms, open pilot study in 97 adults aged 60-100. A study group was given a single dose of 60,000 IU vitamin D3 and a control group was not subject to any intervention. Serum 25(OH)D and calcium were measured at the baseline and after 7 days. Results: 77.32% of studied patients were vitamin deficient, and among those, in 28.87% severe vitamin D deficiency was found. After single administration of 60,000 IU of vitamin D3, only 4 patients achieved recommended serum 25(OH)D concentration. The highest increase in serum 25(OH)D was observed in patients with severe deficiency. Numbers of observed nosocomial infections such as flu, hospital-acquired pneumonia or Klebsiella pneumoniae MBL+ infection did not differ significantly between study and control group, however there was a trend close to significance for lower incidence of Clostridium difficile infection in the vitamin D3 group. Conclusions: Preliminary results of the presented research indicate possible protective effect of single high dose of vitamin D3 against Clostridium difficile infection during hospitalization. Further research on larger group of patients, using higher dose of vitamin D3 is necessary.

scholarly journals Comparison of Common Molecular Typing Methods for Differentiation of Clostridium difficile Strains in the Study of Hospital Acquired Infections

2018 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Masoumeh Azimirad ◽  
Masoud Alebouyeh ◽  
Marjan Rashidan ◽  
Mohammad Mehdi Aslani ◽  
Mohammad Reza Zali
Keyword(s):  
Clostridium Difficile ◽  
Molecular Typing ◽  
Hospital Acquired Infections ◽  
Typing Methods ◽  
Hospital Acquired
Sign in / Sign up

Export Citation Format

Share Document