scholarly journals Toxin gene profiles and antimicrobial resistance of Clostridioides difficile infection: a single tertiary care center study in Iran

2021 ◽  
Author(s):  
Mohammad Sholeh ◽  
Ebrahim Kouhsari ◽  
Malihe Talebi ◽  
Masoumeh Hallajzadeh ◽  
Forough Godarzi ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Biotic Resistance ◽  
Hospitalized Patients ◽  
Toxin Gene ◽  
Gene Profile ◽  
Clostridioides Difficile ◽  
Gene Profiles ◽  
Antibiotic Susceptibility Test ◽  
Clostridioides Difficile Infection ◽  
Stool Samples

Background and Objectives: Due to the reduced susceptibility of clinical Clostridioides difficile strains in hospitals to var- ious antimicrobial agents, the importance of antimicrobial susceptibility testing (ASTs) has increased. This study aimed to investigate the toxin gene profiles and the antimicrobial resistance of C. difficile isolated from hospitalized patients suspected of having Clostridioides difficile infection (CDI) in Tehran, Iran. Materials and Methods: The stool samples were obtained from a hospitalized patients. The samples were shocked by al- cohol and the patients cultured on cycloserine-cefoxitin-fructose agar in anaerobic Conditions. Toxin assay was performed for detection of toxinogenic isolates. An antibiotic susceptibility test was done. Furthermore, their genome was extracted for PCR to confirm C. difficile and detect toxin gene profile. Results: Toxigenic C. difficile were identified in 21 of the 185 stool samples (11.3%). PCR detected seven toxin gene profiles; the highest prevalence was related to tcdA+B+, cdtA+B-  toxin gene profile (57.1%). There were 14.3% and 28.6% resistant rates of the isolates towards vancomycin and metronidazole with the toxin gene profiles; tcdA+B+, cdtA±B+; and tc- dA+B-, cdtA-B+. All resistant isolates to moxifloxacin, clindamycin, and tetracycline were belonged to the toxin gene profiles; tcdA+B+, cdtA+B+; tcdA+B+, cdtA+B-, and tcdA-B+, cdtA+B-. Conclusion: Relative high resistance was detected towards metronidazole and vancomycin, although, still have acceptable activity for CDI treatment. However, a proper plan for the use of antibiotics and more regular screening of C. difficile anti- biotic resistance seems necessary.

scholarly journals Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Lindsay A Petty ◽  
Valerie M Vaughn ◽  
Scott A Flanders ◽  
Twisha Patel ◽  
Anurag N Malani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antibiotic Treatment ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Altered Mental Status ◽  
Estimating Equation ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Cord Injury ◽  
Clostridioides Difficile Infection

Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. Methods We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018–February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Results Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08–1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P = .02). Conclusions Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.

scholarly journals Bile Acid Profile and its Changes in Response to Cefoperazone Treatment in MR1 Deficient Mice

Metabolites ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 127 ◽  
Author(s):  
Jinchun Sun ◽  
Zhijun Cao ◽  
Ashley D. Smith ◽  
Paul E. Carlson Jr ◽  
Michael Coryell ◽  
...  
Keyword(s):  
Bile Acid ◽  
Intestinal Content ◽  
Knock Out ◽  
Mait Cells ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Infection Resistance ◽  
Stool Samples ◽  
Cecum Content ◽  
Microbiome Data

Mucosal associated invariant T-cells (MAIT cells) are activated following recognition of bacterial antigens (riboflavin intermediates) presented on major histocompatibility complex class I-related molecule (MR1). Our previous study showed that MR1−/− knock-out (KO) mice (lacking MAIT cells) harbor a unique microbiota that is resistant to antibiotic disruption and Clostridioides difficile colonization. While we have characterized the microbiota of this mouse strain, changes in global metabolic activity in these KO mice have not been assessed. Here, LC/MS-based untargeted metabolomics was applied to investigate the differences in the metabolome, specifically in the bile acid (BA) profile of wild-type (WT) and MR1−/− KO mice, as well as how antibiotics change these profiles. BA changes were evaluated in the intestinal content, cecum content, and stool samples from MR1−/− mice and WT mice treated with cefoperazone (Cef). Fecal pellets were collected daily and both intestinal and cecal contents were harvested at predetermined endpoints on day 0 (D0), day 1 (D1), day 3 (D3), and day 5 (D5). KO mice exhibited no changes in 6-hydroxymethyl-8-D-ribityllumazine (rRL-6-CH2OH; an MR1-restricted riboflavin derivative) in the stool samples at either time point vs. D0, while WT mice showed significant decreases in rRL-6-CH2OH in the stool samples on all treatment days vs. D0. Metabolomics analysis from cecal and stool samples showed that KO mice had more total BA intensity (KO/WT = ~1.7 and ~3.3 fold higher) than that from WT mice prior to Cef treatment, while the fold change difference (KO/WT = ~4.5 and ~4.4 fold) increased after five days of Cef treatment. Both KO and WT mice showed decreases in total BA intensity in response to Cef treatment, however, less dramatic decreases were present in KO vs. WT mice. Increases in taurocholic acid (TCA) intensity and decreases in deoxycholic acid (DCA) intensity in the stool samples from WT mice were associated with the depletion of certain gut bacteria, which was consistent with the previously reported microbiome data. Furthermore, the non-detected TCA and relatively higher DCA intensity in the KO mice might be related to Clostridioides difficile infection resistance, although this needs further investigation.

Burden and risk factors for inappropriate Clostridioides Difficile infection testing among hospitalized patients

2021 ◽  
Vol 99 (4) ◽  
pp. 115283
Author(s):  
Ellen Axenfeld ◽  
William G. Greendyke ◽  
Jianhua Li ◽  
Daniel A. Green ◽  
Susan Whittier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

The Effect of Saccharomyces boulardii Primary Prevention on Risk of Hospital-onset Clostridioides difficile Infection in Hospitalized Patients Administered Antibiotics Frequently Associated With C. difficile Infection

2020 ◽  
Author(s):  
Eric Wombwell ◽  
Mark E Patterson ◽  
Bridget Bransteitter ◽  
Lisa R Gillen
Keyword(s):  
Odds Ratio ◽  
Retrospective Cohort ◽  
Probiotic Strain ◽  
Saccharomyces Boulardii ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Case Data ◽  
Reduced Risk ◽  
Hospital Prescribing

Abstract Background Hospital-onset Clostridioides difficile infection (HO-CDI) is a costly problem leading to readmissions, morbidity, and mortality. We evaluated the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on the risk of HO-CDI within hospitalized patients administered antibiotics frequently associated with HO-CDI. Methods This retrospective cohort study merged hospital prescribing data with HO-CDI case data. The study assessed patients hospitalized from January 2016 through March 2017 who were administered at least 1 dose of an antibiotic frequently associated with HO-CDI during hospitalization. Associations between S. boulardii administration, including timing, and HO-CDI incidence were evaluated by multivariable logistic regression. Results The study included 8763 patients. HO-CDI incidence was 0.66% in the overall cohort. HO-CDI incidence was 0.56% and 0.82% among patients coadministered S. boulardii with antibiotics and not coadministered S. boulardii, respectively. In adjusted analysis, patients coadministered S. boulardii had a reduced risk of HO-CDI (odds ratio [OR], 0.57 [95% confidence interval {CI}, .33–.96]; P = .04) compared to patients not coadministered S. boulardii. Patients coadministered S. boulardii within 24 hours of antibiotic start demonstrated a reduced risk of HO-CDI (OR, 0.47 [95% CI, .23–.97]; P = .04) compared to those coadministered S. boulardii after 24 hours of antibiotic start. Conclusions Saccharomyces boulardii administered to hospitalized patients prescribed antibiotics frequently linked with HO-CDI was associated with a reduced risk of HO-CDI.

scholarly journals Risk for Clostridioides difficile infection among hospitalized patients associated with multiple healthcare exposures prior to admission

2020 ◽  
Author(s):  
Aaron C Miller ◽  
Daniel K Sewell ◽  
Alberto M Segre ◽  
Sriram V Pemmaraju ◽  
Philip M Polgreen ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Healthcare Associated Infection ◽  
Case Definitions ◽  
Multiple Exposures ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Increase Risk ◽  
Clostridioides Difficile Infection ◽  
Degree Of Association ◽  
Healthcare Associated

Abstract Purpose Clostridioides difficile infections (CDIs) are a common healthcare-associated infection and often used as indicators of hospital safety or quality. However, healthcare exposures occurring prior to hospitalization may increase risk for CDI. We conduct a case-control study comparing hospitalized patients with and without CDI to determine if healthcare exposures prior to hospitalization (i.e., clinic visits, antibiotics, family members with CDI) were associated with increased risk for hospital onset CDI, and how risk varied with time between exposure and hospitalization. Methods Records were collected from a large insurance-claims database from 2001-2017 for hospitalized adult patients. Prior healthcare exposures were identified using inpatient, outpatient, emergency department, and prescription drug claims; results were compared between various CDI case definitions. Results Hospitalized patients with CDI had significantly more frequent healthcare exposures prior to admission. Healthcare visits, antibiotics and family exposures were associated with greater likelihood of CDI during hospitalization. The degree of association diminished with time between exposure and hospitalization. Results were consistent across CDI case definitions. Conclusions Many different prior healthcare exposures appear to increase risk for CDI presenting during hospitalization. Moreover, patients with CDI typically have multiple exposures prior to admission, confounding the ability to attribute cases to a particular stay.

scholarly journals Potential for the current National Healthcare Safety Network (NHSN) >3 days after admission definition of laboratory-identified, healthcare-facility–onset, Clostridioides difficile infection (HO-CDI) to overestimate rates

2020 ◽  
Vol 41 (4) ◽  
pp. 467-468
Author(s):  
Shruti Puri ◽  
Heather Y. Hughes ◽  
Monica D. McCrackin ◽  
Robert Williford ◽  
Mulugeta Gebregziabher ◽  
...  
Keyword(s):  
Healthcare Facility ◽  
National Healthcare ◽  
Clostridioides Difficile ◽  
National Healthcare Safety Network ◽  
Positive Stool ◽  
Clostridioides Difficile Infection ◽  
Stool Samples ◽  
Definition Of

AbstractHealthcare-facility–onset C.difficile LabID events are defined as positive stool samples collected >3 days after hospitalization. Using a definition of >72 hours, we found that 84 of 1013 cases (8.3%) identified as C. difficile LabID events were collected between 48 and 72 hours after admission.

scholarly journals Prevalence and impact of Clostridioides difficile infection among hospitalized patients with coranavirus disease 201 9

JGH Open ◽  
2021 ◽  
Author(s):  
Jessica R Allegretti ◽  
Cheikh Nije ◽  
Emma McClure ◽  
Walker D Redd ◽  
Danny Wong ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection
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