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

Abstract Background : Clostridium difficile is considered to be the main pathogen responsible for hospital-acquired infections in western countries, but few studies on C. difficile have been carried out in China. This study performed a prospective study to describe the prevalence, molecular epidemiological characteristics and risk factors of Clostridium difficile infection (CDI) and Clostridium difficile colonization (CDC) among patients in intensive care units (ICUs), with the aim of providing strategies for efficient CD prevention and control.Methods: Stool samples were collected from adult patients on admission to an 18-bed ICU department, and were anaerobically cultured for C. difficile . The identified isolates were tested for toxin genes, followed by multilocus sequence typing to analyze the genotypes. Patients were divided into CDI, CDC and control groups according to clinical features. The medical records of these groups were collected and further analyzed using logistic regression 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). However, 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 ST-2 was the epidemic clone. In the CDC group, the dominant strains were A+B+ and ST-81 was the epidemic clone.Conclusions: The prevalence of C. difficile colonization and infection in our ICU patients 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 take into consideration the duration of hospital stays, enteral nutrition, underlying comorbidities, as well as the use of combined antibiotics. Moreover, metronidazole could be a protective factor for both CDI and CDC.

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

10.21203/rs.2.13271/v2 ◽

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 .

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Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China

10.21203/rs.2.13271/v4 ◽

2019 ◽

Author(s):

Yingchao Cui ◽

Danfeng Dong ◽

Lihua Zhang ◽

Daosheng Wang ◽

Cen Jiang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Stay ◽

Large Scale ◽

Protective Factor ◽

Epidemic Clone ◽

Clostridioides Difficile ◽

And Control ◽

Epidemiological Characteristics

Abstract Background: Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. Methods: Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR=13.993), metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or combined antibiotics (OR=2.856). CDC patients were characterized by prolonged hospital stay (OR=1.137), increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043), and treatment with vancomycin (OR=18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR=0.042; CDC: OR=0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A+B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A+B+ and the epidemic clone was ST81. Conclusions: The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile . Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.

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Evaluation of risk factors for mortality in intensive care units: A prospective study from a referral hospital in Turkey

American Journal of Infection Control ◽

10.1016/j.ajic.2004.09.005 ◽

2005 ◽

Vol 33 (1) ◽

pp. 42-47 ◽

Cited By ~ 26

Author(s):

Aylin Colpan ◽

Esragul Akinci ◽

Ayse Erbay ◽

Neriman Balaban ◽

Hurrem Bodur

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Prospective Study ◽

Intensive Care Units ◽

Referral Hospital ◽

A Prospective Study

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Effects of a predictive preventive model for prevention of Clostridium difficile infection in patients in intensive care units

American Journal of Infection Control ◽

10.1016/j.ajic.2015.11.010 ◽

2016 ◽

Vol 44 (4) ◽

pp. 421-424 ◽

Cited By ~ 11

Author(s):

Alba Cruz-Betancourt ◽

Christopher D. Cooper ◽

Kathleen Sposato ◽

Hermanda Milton ◽

Patricia Louzon ◽

...

Keyword(s):

Intensive Care ◽

Clostridium Difficile ◽

Intensive Care Units ◽

Clostridium Difficile Infection

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Is Clostridium difficile infection an increasingly common severe disease in adult intensive care units? A 10-year experience

Journal of Critical Care ◽

10.1016/j.jcrc.2015.02.011 ◽

2015 ◽

Vol 30 (3) ◽

pp. 543-549 ◽

Cited By ~ 17

Author(s):

E. Bouza ◽

M. Rodríguez-Créixems ◽

L. Alcalá ◽

M. Marín ◽

V. De Egea ◽

...

Keyword(s):

Intensive Care ◽

Clostridium Difficile ◽

Intensive Care Units ◽

Clostridium Difficile Infection ◽

Severe Disease

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Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China

10.21203/rs.2.13271/v3 ◽

2019 ◽

Author(s):

Yingchao Cui ◽

Danfeng Dong ◽

Lihua Zhang ◽

Daosheng Wang ◽

Cen Jiang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Stay ◽

Large Scale ◽

Protective Factor ◽

Epidemic Clone ◽

Clostridioides Difficile ◽

And Control ◽

Epidemiological Characteristics

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A prospective study on the comparison of contamination rate and risk factors of blood culture done in the emergency department and medical high-dependency unit/medicine intensive care units

Current Medical Issues ◽

10.4103/cmi.cmi_59_19 ◽

2020 ◽

Vol 18 (1) ◽

pp. 7

Author(s):

Darpanarayan Hazra ◽

Pranav Kumar ◽

AnkitaChowdary Nekkanti ◽

Mamta Madhiyazhagan ◽

Thomas Sundarshanam ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Intensive Care ◽

Blood Culture ◽

Prospective Study ◽

Intensive Care Units ◽

Contamination Rate ◽

High Dependency Unit ◽

High Dependency ◽

A Prospective Study

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Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China

BMC Infectious Diseases ◽

10.1186/s12879-019-4603-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Yingchao Cui ◽

Danfeng Dong ◽

Lihua Zhang ◽

Daosheng Wang ◽

Cen Jiang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Stay ◽

Large Scale ◽

Protective Factor ◽

Epidemic Clone ◽

Clostridioides Difficile ◽

And Control ◽

Epidemiological Characteristics

Abstract Background Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. Methods Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. Results Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR = 13.993), metabolic disorder (OR = 7.972), and treatment with fluoroquinolone (OR = 42.696) or combined antibiotics (OR = 2.856). CDC patients were characterized by prolonged hospital stay (OR = 1.137), increased number of comorbidities (OR = 36.509), respiratory diseases (OR = 0.043), and treatment with vancomycin (OR = 18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR = 0.042; CDC: OR = 0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A + B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A + B+ and the epidemic clone was ST81. Conclusions The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile. Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.

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CLOSTRIDIUM DIFFICILE IN DOLJ COUNTY (ROMANIA) – SURVEILLANCE INFORMATION 2015 TO 2016

Romanian Journal of Infectious Diseases ◽

10.37897/rjid.2017.1.2 ◽

2017 ◽

Vol 20 (1) ◽

pp. 14-19

Author(s):

Livia Dragonu ◽

◽

Augustin Cupsa ◽

Ana Bobarnac ◽

Ludmila Prunariu ◽

...

Keyword(s):

Infectious Disease ◽

Risk Factors ◽

Intensive Care ◽

Retrospective Study ◽

Clostridium Difficile ◽

Medical Unit ◽

Factors Associated ◽

Medical Facilities ◽

Epidemiological Characteristics ◽

Age Over 60

Objectives. The paper aims epidemiological characteristics of the nosocomial infection with Clostridium difficile (CDIn) based on surveillance data reported by medical facilities in Dolj County (Romania). Methods. We performed a retrospective study (January 2015 – December 2016) of 506 files with declaration of cases of C. difficile infections (CDI) recorded in adults. Results. CDIn represented 83.7% of the cases of CDI, an increase from 13.8 cases/month in 2015 to 21.5 cases/month in 2016. The symptoms began after discharge in 46.6% of cases and during hospitalization for 53.4% of the reported cases. The illness origin was in 47.8% of cases in a medical unit different from the reporting one. The number of CDIn was higher in the infectious disease wards (0.73 cases/bed/year) and intensive care (0.3 cases/bed/year). The main risk factors were the antibiotics administration (87.1%) and the age over 60 (69.3% of cases). The lethality by CDIn was 2.1% and in 5.7% of the cases, death being produced by aggravation of the associated pathology. Conclusions. The implementation of the CDI surveillance contributed to Dolj County to improve monitoring and identification of the risk factors associated to this disorder.

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