scholarly journals High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya

2021 ◽  
Vol 10 ◽  
Author(s):  
Winnie C. Mutai ◽  
Marianne W. Mureithi ◽  
Omu Anzala ◽  
Gunturu Revathi ◽  
Brian Kullin ◽  
...  
Keyword(s):  
Diarrheal Disease ◽  
Egg Yolk ◽  
Healthcare Facility ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Binary Toxin ◽  
Toxin Gene ◽  
African Countries ◽  
Cross Sectional ◽  
Clostridioides Difficile

IntroductionClostridioides difficile is a neglected pathogen in many African countries as it is generally not regarded as one of the major contributors toward the diarrheal disease burden in the continent. However, several studies have suggested that C. difficile infection (CDI) may be underreported in many African settings. The aim of this study was to determine the prevalence of CDI in hospitalized patients, evaluate antimicrobial exposure, and detect toxin and antimicrobial resistance profiles of the isolated C. difficile strains.MethodsIn this cross-sectional study, 333 hospitalized patients with hospital-onset diarrhoea were selected. The stool samples were collected and cultured on cycloserine-cefoxitin egg yolk agar (CCEY). Isolates were presumptively identified by phenotypic characteristics and Gram stain and confirmed by singleplex real-time PCR (qPCR) assays detecting the species-specific tpi gene, toxin A (tcdA) gene, toxin B (tcdB) gene, and the binary toxin (cdtA/cdtB) genes. Confirmed C. difficile isolates were tested against a panel of eight antimicrobials (vancomycin, metronidazole, rifampicin, ciprofloxacin, tetracycline, clindamycin, erythromycin, and ceftriaxone) using E-test strips.ResultsC. difficile was detected in 57 (25%) of diarrheal patients over the age of two, 56 (98.2%) of whom received antimicrobials before the diarrheal episode. Amongst the 71 confirmed isolates, 69 (97.1%) harbored at least one toxin gene. More than half of the toxigenic isolates harbored a truncated tcdA gene. All isolates were sensitive to vancomycin, while three isolates (2.1%) were resistant to metronidazole (MIC >32 mg/L). High levels of resistance were observed to rifampicin (65/71, 91.5%), erythromycin (63/71, 88.7%), ciprofloxacin (59/71, 83.1%), clindamycin (57/71, 80.3%), and ceftriaxone (36/71, 50.7.8%). Among the resistant isolates, 61 (85.9%) were multidrug-resistant.ConclusionMultidrug-resistant C. difficile strains were a significant cause of healthcare facility-onset C. difficile infections in patients with prior antimicrobial exposure in this Kenyan hospital.

scholarly journals Correlation of prevention practices with rates of health care-associated Clostridioides difficile infection

2019 ◽  
Vol 41 (1) ◽  
pp. 52-58
Author(s):  
Jackson S. Musuuza ◽  
Linda McKinley ◽  
Julie A. Keating ◽  
Chidi Obasi ◽  
Mary Jo Knobloch ◽  
...  
Keyword(s):  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Contact Precautions ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Bed Days ◽  
Acute Care Facilities

AbstractObjective:We examined Clostridioides difficile infection (CDI) prevention practices and their relationship with hospital-onset healthcare facility-associated CDI rates (CDI rates) in Veterans Affairs (VA) acute-care facilities.Design:Cross-sectional study.Methods:From January 2017 to February 2017, we conducted an electronic survey of CDI prevention practices and hospital characteristics in the VA. We linked survey data with CDI rate data for the period January 2015 to December 2016. We stratified facilities according to whether their overall CDI rate per 10,000 bed days of care was above or below the national VA mean CDI rate. We examined whether specific CDI prevention practices were associated with an increased risk of a CDI rate above the national VA mean CDI rate.Results:All 126 facilities responded (100% response rate). Since implementing CDI prevention practices in July 2012, 60 of 123 facilities (49%) reported a decrease in CDI rates; 22 of 123 facilities (18%) reported an increase, and 41 of 123 (33%) reported no change. Facilities reporting an increase in the CDI rate (vs those reporting a decrease) after implementing prevention practices were 2.54 times more likely to have CDI rates that were above the national mean CDI rate. Whether a facility’s CDI rates were above or below the national mean CDI rate was not associated with self-reported cleaning practices, duration of contact precautions, availability of private rooms, or certification of infection preventionists in infection prevention.Conclusions:We found considerable variation in CDI rates. We were unable to identify which particular CDI prevention practices (i.e., bundle components) were associated with lower CDI rates.

scholarly journals Diagnosis of Clostridioides difficile infection by analysis of volatile organic compounds in breath, plasma, and stool: A cross-sectional proof-of-concept study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256259
Author(s):  
Teny M. John ◽  
Nabin K. Shrestha ◽  
Gary W. Procop ◽  
David Grove ◽  
Sixto M. Leal ◽  
...  
Keyword(s):  
Volatile Organic Compounds ◽  
Organic Compounds ◽  
Clinical Features ◽  
Toxin Gene ◽  
Proof Of Concept ◽  
Cross Sectional ◽  
Concept Study ◽  
Clostridioides Difficile ◽  
Volatile Organic ◽  
Selected Ion Flow Tube

Clostridioides difficile infection (CDI) is an important infectious cause of antibiotic-associated diarrhea, with significant morbidity and mortality. Current diagnostic algorithms are based on identifying toxin by enzyme immunoassay (EIA) and toxin gene by real-time polymerase chain reaction (PCR) in patients with diarrhea. EIA’s sensitivity is poor, and PCR, although highly sensitive and specific, cannot differentiate infection from colonization. An ideal test that incorporates microbial factors, host factors, and host-microbe interaction might characterize true infection, and assess prognosis and recurrence. The study of volatile organic compounds (VOCs) has the potential to be an ideal diagnostic test. The presence of VOCs accounts for the characteristic odor of stool in CDI but their presence in breath and plasma has not been studied yet. A cross-sectional proof-of-concept study analyzing VOCs using selected ion flow tube mass spectrometry (SIFT-MS) was done on breath, stool, and plasma of patients with clinical features and positive PCR for CDI (cases) and compared with patients with clinical features but a negative PCR (control). Our results showed that VOC patterns in breath, stool, and plasma, had good accuracy [area under the receiver operating characteristic curve (ROC) 93%, 86%, and 91%, respectively] for identifying patients with CDI.

scholarly journals Molecular epidemiology of community-onset Clostridioides difficile infections at a tertiary hospital in mainland China: A ten-year (2010-2019) retrospective study

2021 ◽  
Author(s):  
Yunbo Chen ◽  
Lihong Bu ◽  
Tao Lv ◽  
Lisi Zheng ◽  
Silan Gu ◽  
...  
Keyword(s):  
Molecular Epidemiology ◽  
Mainland China ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Binary Toxin ◽  
Common Disease ◽  
High Genetic Diversity ◽  
Toxin Genes ◽  
Clostridioides Difficile ◽  
Community Onset

Abstract Background Clostridioides difficile infection (CDI) is an increasingly common disease in healthcare facilities and community settings. However, there are limited reports of community-onset CDI (CO-CDI) in China. We retrospectively analyzed the molecular epidemiology of CO-CDI at a tertiary hospital over a period of 10 years. Methods A total of 1307 stool samples from 1213 outpatients were tested by culturing. The presence of toxin genes (tcd A, tcd B, cdtA and cdtB) were confirmed by PCR. Toxigenic strains were typed using multilocus sequence typing (MLST). Susceptibility to 9 antimicrobials was evaluated using the E-test. Results Eighty-nine of 1213 outpatients (7.3%) had CO-CDI, 4 of these patients (4.5%) had one or more recurrence, and there were 95 strains of toxigenic C. difficile. Among these strains, 82 (86.3%) had the tcdA and tcdB genes (A + B+) and 5 of these 82 strains were positive for the binary toxin genes (cdtA and cdtB); the other 13 strains (13.7%) had the tcdB gene only (A-B+). There were 15 different STs and the most prevalent were ST-54 (23.2%), ST-35 (16.8%), and ST-2 (13.7%). All strains were susceptible to metronidazole and vancomycin, and had low resistance to moxifloxacin and tetracycline, but had high resistance to ciprofloxacin, clindamycin, and erythromycin. Twenty-three isolates (24.2%) were multidrug-resistant. Conclusions Outpatients with CDI were common during this period in our hospital. The C. difficile isolates had high genetic diversity. All isolates were susceptible to metronidazole and vancomycin, and nearly one quarter of all isolates had multidrug resistance.

scholarly journals Eosinopenia and Binary Toxin Increase Mortality in Hospitalized Patients With Clostridioides difficile Infection

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Travis J Carlson ◽  
Bradley T Endres ◽  
Julie Le Pham ◽  
Anne J Gonzales-Luna ◽  
Faris S Alnezary ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Hospitalized Patients ◽  
Binary Toxin ◽  
Inpatient Mortality ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
National Cohort ◽  
The Relationship

Abstract Background Patients with Clostridioides difficile infection (CDI) with either eosinopenia or infected with a binary toxin strain have increased likelihood of mortality. However, the relationship between binary toxin and eosinopenia to synergistically increase mortality has not been studied in humans. We hypothesized that patients with CDI due to binary toxin strains and concomitant peripheral eosinopenia would have a higher likelihood of inpatient mortality. Methods This multicenter, retrospective cohort study included adult patients with CDI of known ribotypes stratified by eosinopenia, defined as an absence of eosinophils in the peripheral blood (Houston cohort). The primary outcome was inpatient mortality. Results were supported by a separate national cohort of veterans with CDI (Veterans’ cohort). Results In the Houston cohort, a total of 688 patients from 13 institutions in 6 cities were included. Of these, 132 (19%) had an eosinophil count of 0.0 cells/µL (0.0 cells*109/L) and 109 (16%) were infected with a binary toxin strain. After adjusting for covariates, the combination of eosinopenia and infection with a binary toxin strain was an independent predictor of inpatient mortality (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.9–33.2; P = .005). In the separate Veterans’ cohort (n = 790), this combination was also a significant predictor of inpatient mortality (OR, 6.1; 95% CI, 1.5–23.9; P = .009). Conclusions In conclusion, the combination of eosinopenia and CDI due to a binary toxin strain was correlated with increased mortality in hospitalized patients from 2 independent cohorts. Prospective studies should further study this important subset of patients at the time of CDI diagnosis.

scholarly journals Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018

2020 ◽  
Vol 58 (11) ◽  
Author(s):  
Stacey Hong ◽  
Papanin Putsathit ◽  
Narelle George ◽  
Christine Hemphill ◽  
Peter G. Huntington ◽  
...  
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Diarrheal Disease ◽  
Gene Profiling ◽  
Binary Toxin ◽  
Toxin Gene ◽  
Community Settings ◽  
Content Type ◽  
Australian Health ◽  
Diagnostic Microbiology

ABSTRACT In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.

scholarly journals Characterization of Clostridioides difficile strains, the disease severity and the microbial changes they induce

2020 ◽  
Author(s):  
Hanan Rohana ◽  
Maya Azrad ◽  
Orna Nitzan ◽  
Amos Adler ◽  
Omry Koren ◽  
...  
Keyword(s):  
Disease Severity ◽  
Antimicrobial Agents ◽  
Intestinal Microbiome ◽  
Binary Toxin ◽  
Toxin Gene ◽  
Clostridioides Difficile ◽  
Severity Of The Disease ◽  
Phylogenetic Lineages ◽  
Clade 1 ◽  
Different Strains

Abstract Background In recent years, the global incidence of Clostridioides difficile infection has increased dramatically, with the emergence of hyper-virulent strains. The characteristics of the different strains, the severity of the disease they cause, their susceptibility to antimicrobial agents, and the changes they inflict on the gut microbiome, have not yet been comprehensively studied. Results Using Multilocus Sequencing Typing (MLST) analysis, the different sequence types (STs) of 70 clinical isolates were determined. The most frequent strains were ST04 (22.5%), ST37 (12.7%), ST104 (8.5%), ST42 (7%), and ST02 (7%). The different STs were divided to different phylogenetic lineages (clades), with clade 1 forming the majority of cases (81.4%, 57/70). A significant correlation was found between ST and age (p = 0.024); patients with ST104 (n = 6) were of the lowest mean age (61.67 ± 18.8 years), while patients with ST37 (n = 9) were of the oldest mean age (79.67 ± 10.6 years). In addition, a significant correlation between ST and susceptibility to moxifloxacin was identified (p = 0.001); 15 ST04 isolates (93.7%, n = 16) were resistant, while all ST42 (n = 5) and ST104 isolates (n = 6) were sensitive. Significant correlations were found between clade and binary toxin gene presence (p = 0.002), with 93% of the isolates belonging to clade 1 lacking the gene. Furthermore, significant correlations were found between clade and susceptibility to both metronidazole and vancomycin (p = 0.024, p = 0.035, respectively). Differences in intestinal microbiome were affected by age, clade distribution and ST. Conclusions By defining the characteristics of the different strains and clades, clinicians can choose medical interventions based on the predicted response or disease severity associated with each strain, enabling new advances in the field of personalized medicine.

scholarly journals Characterization of Clostridioides difficile Strains, the Disease Severity, and the Microbial Changes They Induce

2020 ◽  
Vol 9 (12) ◽  
pp. 4099
Author(s):  
Hanan Rohana ◽  
Maya Azrad ◽  
Orna Nitzan ◽  
Amos Adler ◽  
Dana Binyamin ◽  
...  
Keyword(s):  
Disease Severity ◽  
Gut Microbiome ◽  
Binary Toxin ◽  
Toxin Gene ◽  
Medical Interventions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Susceptibility Tests ◽  
Nosocomial Disease ◽  
Different Strains

Background: Clostridioides difficile infection (CDI) is a major nosocomial disease. The characteristics of different strains, the disease severity they cause, their susceptibility to antibiotics, and the changes they inflict on gut microbiome, have not been comprehensively studied in Israel. Methods: A severity score was calculated for 70 patients. Stool samples were tested for toxins presence using a special kit. Bacteria were isolated, identified by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) and antibiotic susceptibility tests were performed for several antibiotics. Strains were classified by Multi-locus sequence typing (MLST), and changes in gut microbiome were tested. Results: ST04 (22.5%) and ST37 (12.7%) were the most frequent strains. Clade (phylogenetic lineage) 1 was the most (81.4%) prevalent. We found significant associations between ST and age (p = 0.024) and between ST and moxifloxacin susceptibility (p = 0.001). At the clade level, we found significant associations with binary toxin gene occurrence (p = 0.002), and with susceptibility to both metronidazole and vancomycin (p = 0.024, 0.035, respectively). Differences in intestine microbiome were affected by age, clades’ distribution and STs. Conclusions: By defining the characteristics of the different strains and clades, clinicians can choose medical interventions based on the predicted response or disease severity associated with each strain, enabling new advances in the field of personalized medicine.

scholarly journals Epidemiology and Outcomes of Patients With Healthcare Facility–Onset Clostridioides difficile Infection

2021 ◽  
Author(s):  
Matthew D Eberly ◽  
Apryl Susi ◽  
Daniel J Adams ◽  
Christopher S Love ◽  
Cade M Nylund
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Costs ◽  
Healthcare Facility ◽  
Case Mix ◽  
Cross Sectional ◽  
Military Health ◽  
Hospitalization Cost ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

ABSTRACT Background Clostridioides difficile infection (CDI) has become a rising public health threat. Our study aims to characterize the epidemiology and measure the attributable cost, length of stay, and in-hospital mortality of healthcare facility–onset Clostridioides difficile infection (HO-CDI) among patients in the U.S. Military Health System (MHS). Methods We performed a case–control and cross-sectional inpatient study of HO-CDI using MHS database billing records. Cases included those who were at least 18 years of age admitted to a military treatment facility with a stool sample positive for C. difficile obtained >3 days after admission. Risk factors in the preceding year were identified. Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjusted logistic regression. Results Among 474,518 admissions within the MHS from 2008 to 2015, we identified 591 (0.12%) patients with HO-CDI and found a significant increase in the trend of HO-CDI over the 7-year study period (P < .001). Patients with HO-CDI had significantly higher hospitalization cost (attributable difference $66,044, P < .001), prolonged hospital stay (attributable difference 12.4 days, P < 0.001), and increased odds of in-hospital mortality (case-mix adjusted odds ratio 1.98; 95% CI, 1.43-2.74). Conclusions Healthcare facility–onset Clostridioides difficile infection is rising in patients within the MHS and is associated with increased length of stay, hospital costs, and in-hospital mortality. We identified a significantly increased burden of hospitalization among patients admitted with HO-CDI, highlighting the importance of infection control and antimicrobial stewardship initiatives aimed at decreasing the spread of this pathogen.

scholarly journals Community-Onset Clostridioides Difficile Infection in Hospitalized Patients in The Netherlands

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
M J T Crobach ◽  
D W Notermans ◽  
C Harmanus ◽  
I M J G Sanders ◽  
S C De Greeff ◽  
...  
Keyword(s):  
The Netherlands ◽  
Healthcare Facility ◽  
Hospitalized Patients ◽  
Surveillance Program ◽  
Reference Laboratory ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Surveillance Programs ◽  
Outpatient Settings ◽  
Community Onset

Abstract Background Clostridioides difficile infection (CDI) is increasingly reported in the community. The aim of this study was to analyze characteristics of hospitalized patients with community-onset CDI (CO-CDI). Methods In the Netherlands, 24 hospitals (university-affiliated and general hospitals) participate in the sentinel CDI surveillance program. Clinical characteristics and 30-day outcomes of hospitalized patients >2 years old diagnosed with CDI are registered. Samples of these patients are sent to the national reference laboratory for polymerase chain reaction ribotyping. Data obtained for this surveillance from May 2012 to May 2018 were used to compare CO-CDI with hospital-onset (HO)-CDI episodes. Results Of 5405 registered cases, 2834 (52.4%) were reported as HO-CDI, 2174 (40.2%) were CO-CDI, and 339 (6.3%) had onset of symptoms in another healthcare facility (eg, nursing home). The proportion of CO-CDI increased over the years and was lower during winter months. Hospitalized patients with CO-CDI were younger (63.8 vs 68.0 years, P < .001) and more often females (53.0% vs 49.6%, P = .02) than patients with HO-CDI. Median time between onset of symptoms and CDI testing was longer in CO-CDI (4 vs 1 day, P < .001). Similar ribotypes were found in CO-CDI and HO-CDI, but ribotype 001 was more frequent among HO-CDI, whereas ribotype 023 was more frequent in CO-CDI. Six of 7 (85.7%) surgeries due to CDI, 27 of 50 (54%) ICU admissions due to CDI, and 48 of 107 (44.9%) of CDI-associated deaths were attributable to CO-CDI. Conclusions Our study demonstrates that patients hospitalized with CO-CDI contribute substantially to the total number of CDI episodes and CDI-associated complications in hospitals, stressing the need for awareness and early testing for CDI in community and outpatient settings and also in patients admitted from community with diarrhoea. Surveillance programs that also target nonhospitalized CDI patients are needed to understand the true burden and dynamics of CDI.

scholarly journals A retrospective cross-sectional survey on nosocomial bacterial infections and their antimicrobial susceptibility patterns in hospitalized patients in northwest of Iran

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Hamid Sadeghi ◽  
Saeideh Gholamzadeh Khoei ◽  
Mehdi Bakht ◽  
Mohammad Rostamani ◽  
Sara Rahimi ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Bacterial Infections ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Antimicrobial Susceptibility Pattern ◽  
High Prevalence ◽  
Susceptibility Patterns

Abstract Objective Nosocomial infections (NIs) are known as one of the remarkable problems in all countries. This study is aimed to estimate the prevalence rate of nosocomial bacterial agents with antimicrobial susceptibility pattern in hospitalized patients. This study was conducted from April 2017 to September 2018, on 4029 hospitalized patients. We set out to recognize the commonest bacterial infections and antimicrobial susceptibility patterns of nosocomial infection. Results Of the 4029 patients, 509 (12.6%) of them were culture positive. Of these Escherichia coli (E. coli) (98.3%) and Staphylococcus epidermidis (S. epidermidis) (37.5%) were the most abundant bacterial identified in the urinary tract and bloodstream cultures respectively, Moreover, Acinetobacter spp. (100%) and Pseudomonas aeruginosa (22.2%) were the most abundant organisms detected in the respiratory system. According to susceptibility testing results, 370 (80.5%) and 264 (57.3%) in Gram-negatives and 44 (91.7%) and 35 (72.9%) in gram positives isolated strains were classified as multidrug-resistant (MDR) and extensive drug-resistant (XDR) strain respectively. On account of the high prevalence of MDR and XDR bacterial species, there is a pressing need for the expansion of new strategies on antibiotic supervision and infection control to introduce new guideline on empirical antibiotic therapy.

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