scholarly journals The Burden of Clostridioides Difficile Infection during the COVID-19 Pandemic: A Retrospective Case-Control Study in Italian Hospitals (CloVid)

2020 ◽  
Vol 9 (12) ◽  
pp. 3855
Author(s):  
Guido Granata ◽  
Alessandro Bartoloni ◽  
Mauro Codeluppi ◽  
Ilaria Contadini ◽  
Francesco Cristini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Infections ◽  
Infection Prevention And Control ◽  
Retrospective Case ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Hospital Stays ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

Data on the burden of Clostridioides difficile infection (CDI) in Coronavirus Disease 2019 (COVID-19) patients are scant. We conducted an observational, retrospective, multicenter, 1:3 case (COVID-19 patients with CDI)-control (COVID-19 patients without CDI) study in Italy to assess incidence and outcomes, and to identify risk factors for CDI in COVID-19 patients. From February through July 2020, 8402 COVID-19 patients were admitted to eight Italian hospitals; 38 CDI cases were identified, including 32 hospital-onset-CDI (HO-CDI) and 6 community-onset, healthcare-associated-CDI (CO-HCA-CDI). HO-CDI incidence was 4.4 × 10,000 patient-days. The percentage of cases recovering without complications at discharge (i.e., pressure ulcers, chronic heart decompensation) was lower than among controls (p = 0.01); in-hospital stays was longer among cases, 35.0 versus 19.4 days (p = 0.0007). The presence of a previous hospitalisation (p = 0.001), previous steroid administration (p = 0.008) and the administration of antibiotics during the stay (p = 0.004) were risk factors associated with CDI. In conclusions, CDI complicates COVID-19, mainly in patients with co-morbidities and previous healthcare exposures. Its association with antibiotic usage and hospital acquired bacterial infections should lead to strengthen antimicrobial stewardship programmes and infection prevention and control activities.

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 .

scholarly journals Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhijie Zhang ◽  
Yu Cao ◽  
Yanjian Li ◽  
Xufang Chen ◽  
Chen Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Biofilm Formation ◽  
Prevention And Control ◽  
Neonatal Intensive Care ◽  
Infection Prevention ◽  
Infection Prevention And Control ◽  
Anti Fungal ◽  
Hospital Acquired ◽  
And Control

Abstract Background Candida pelliculosa is an ecological fungal species that can cause infections in immunocompromised individuals. Numerous studies globally have shown that C. pelliculosa infects neonates. An outbreak recently occurred in our neonatal intensive care unit; therefore, we aimed to evaluate the risk factors in this hospital-acquired fungal infection. Methods We performed a case-control study, analysing the potential risk factors for neonatal infections of C. pelliculosa so that infection prevention and control could be implemented in our units. Isolated strains were tested for drug resistance and biofilm formation, important factors for fungal transmission that give rise to hospital-acquired infections. Results The use of three or more broad-spectrum antimicrobials or long hospital stays were associated with higher likelihoods of infection with C. pelliculosa. The fungus was not identified on the hands of healthcare workers or in the environment. All fungal isolates were susceptible to anti-fungal medications, and after anti-fungal treatment, all infected patients recovered. Strict infection prevention and control procedures efficiently suppressed infection transmission. Intact adhesin-encoding genes, shown by genome analysis, indicated possible routes for fungal transmission. Conclusions The use of three or more broad-spectrum antimicrobials or a lengthy hospital stay is theoretically associated with the risk of infection with C. pelliculosa. Strains that we isolated are susceptible to anti-fungal medications, and these were eliminated by treating all patients with an antifungal. Transmission is likely via adhesion to the cell surface and biofilm formation.

Hospital acquired Clostridioides difficile infection and risk factors for severity in a university hospital: A prospective study

2020 ◽  
Vol 48 (12) ◽  
pp. 1426-1430
Author(s):  
Hüseyin Bilgin ◽  
Elvan Sayın ◽  
Hande Perk Gürün ◽  
Elif Tükenmez-Tigen ◽  
Nurver Ülger Toprak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
University Hospital ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
A Prospective Study ◽  
Hospital Acquired

scholarly journals Risk Factors for BI/NAP1/027 Clostridioides difficile Infections and Clinical Outcomes Compared With Non-NAP1 Strains

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Nandita S Mani ◽  
John B Lynch ◽  
Ferric C Fang ◽  
Jeannie D Chan
Keyword(s):  
Risk Factors ◽  
Proton Pump Inhibitor ◽  
Clinical Outcomes ◽  
Case Control ◽  
Nursing Facilities ◽  
Single Center ◽  
Retrospective Case ◽  
Skilled Nursing ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract We aim to describe the characteristics, risk factors, and clinical outcomes associated with NAP1 strain Clostridioides difficile infection (CDI) in this single-center, retrospective, case–control (1:1) study. We found that the NAP1 strain accounted for 19.7% of CDI, and risk factors for acquisition included residence in skilled nursing facilities, previous CDI, and proton pump inhibitor use.

scholarly journals Clostridioides difficile infection in patients with end stage renal disease. Is it preventable?

2020 ◽  
pp. 11-21
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Significant Risk ◽  
Medical Personnel ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Stage Renal Disease ◽  
End Stage ◽  
Healthcare Associated

Clostridioides difficile infection (CDI) is a leading cause of a healthcare-associated diarrhea worldwide. Recently, an increased number of new cases and growing mortality due to CDI have been observed. Patients suffering from end-stage renal disease (ESRD) are most exposed to CDI. It has been proven that CDI in patients receiving renal replacement therapy (RRT) significantly increases mortality, prolongs hospitalization and increases the cost of treatment. Important risk factors of CDI in ERSD patients include hospitalization or stay in an intensive care unit in the last 90 days, HIV infection, bacteremia, prolonged antibiotic therapy and hypoalbuminemia. Cirrhosis, age over 65 years, hypoalbuminemia, longer hospitalization time and use of antibiotics are significant risk factors of death. Effective methods of preventing CDI include hand hygiene with soap and water, isolation of infected patients in a private room with a dedicated toilet, the use of masks, gloves, disinfection of the environment and systematic education and control of medical personnel, as well as rational antibiotic policy. In addition, it is important to avoid antibiotics with a proven risk of CDI, caution use of proton pump inhibitors (PPI) and H2 receptor antagonists. It is also important in the prevention of CDI in people with ERSD, to apply a fast diagnostic since the onset of the first symptoms. The use of probiotics and bile acids in the primary prevention of CDI requires further research. It seems that knowledge of these factors and methods of prevention will significantly reduce morbidity and mortality due to CDI.

scholarly journals Bactericidal and Bacteriostatic Antibiotics

2021 ◽  
Author(s):  
Sachin M. Patil ◽  
Parag Patel
Keyword(s):  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Vital Role ◽  
Mortality And Morbidity ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Multiple Trials ◽  
Outpatient Settings ◽  
Red Dye ◽  
Hospital Acquired

Of all the medications available to physicians worldwide, antibiotics play an essential role in inpatient and outpatient settings. Discovered in the early nineteenth century by Alexander Fleming, penicillin was the first antibiotic isolated from a mold. Dr. Gerhard Domagk developed synthetic sulfa drugs by altering the red dye used in chemical industries. Since then, multiple antibiotic classes have been discovered with varying antimicrobial effects enabling their use empirically or in specific clinical scenarios. Antibiotics with different mechanisms of action could be either bactericidal or bacteriostatic. However, no clinical significance has been observed between cidal and static antibiotics in multiple trials. Their presence has led to safer deep invasive surgeries, advanced chemotherapy in cancer, and organ transplantation. Indiscriminate usage of antibiotics has resulted in severe hospital-acquired infections, including nosocomial pneumonia, Clostridioides difficile infection, multidrug-resistant invasive bacterial infections, allergic reactions, and other significant side effects. Antibiotic stewardship is an essential process in the modern era to advocate judicial use of antibiotics for an appropriate duration. They play a vital role in medical and surgical intensive care units to address the various complications seen in these patients. Antibiotics are crucial in severe acute infections to improve overall mortality and morbidity.

scholarly journals Nosocomial Transmission of Coronavirus Disease 2019: A Retrospective Study of 66 Hospital-acquired Cases in a London Teaching Hospital

2020 ◽  
Author(s):  
Hannah M Rickman ◽  
Tommy Rampling ◽  
Karen Shaw ◽  
Gema Martinez-Garcia ◽  
Leila Hail ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Infection Prevention ◽  
Case Fatality ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Infection Rates ◽  
Prevention And Control Measures ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

Abstract Coronavirus disease 2019 (COVID-19) can cause deadly healthcare-associated outbreaks. In a major London teaching hospital, 66 of 435 (15%) COVID-19 inpatient cases between 2 March and 12 April 2020 were definitely or probably hospital-acquired, through varied transmission routes. The case fatality was 36%. Nosocomial infection rates fell following comprehensive infection prevention and control measures.

scholarly journals Hand Hygiene Practices to Reduce Hospital Acquired Infection

2019 ◽  
pp. 1-4
Author(s):  
Liana Monica DEAC Babes ◽  
Keyword(s):  
Hand Hygiene ◽  
Personal Hygiene ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Effective Measure ◽  
Hospital Acquired Infection ◽  
Hygiene Practices ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

Hands are the most effective mode of transfer of microorganism in healthcare and can result in healthcare associated infections which are major causes of morbidity and mortality worldwide. Reduction of infection by this mode of transfer can be achieved by a simple but very effective measure of performing hand hygiene at the appropriate time which is one of the most fundamental principles in infection prevention and control. Good hand hygiene practices have been shown to reduce healthcare associated infections. Hand washing with soap and water has been considered a measure of personal hygiene for several years

scholarly journals Clostridioides difficile Whole-genome Sequencing Differentiates Relapse With the Same Strain From Reinfection With a New Strain

2020 ◽  
Author(s):  
Janice Cho ◽  
Scott Cunningham ◽  
Meng Pu ◽  
Ryan J Lennon ◽  
Jennifer Dens Higano ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Sequence Data ◽  
Infection Prevention And Control ◽  
Whole Genome ◽  
Clostridioides Difficile ◽  
Allelic Differences ◽  
Clostridioides Difficile Infection ◽  
And Control ◽  
Zip Code

Abstract Background Current approaches in tracking Clostridioides difficile infection (CDI) and individualizing patient management are incompletely defined. Methods We recruited 468 subjects with CDI at Mayo Clinic Rochester between May and December 2016 and performed whole-genome sequencing (WGS) on C. difficile isolates from 397. WGS was also performed on isolates from a subset of the subjects at the time of a recurrence of infection. The sequence data were analyzed by determining core genome multilocus sequence type (cgMLST), with isolates grouped by allelic differences and the predicted ribotype. Results There were no correlations between C. difficile isolates based either on cgMLST or ribotype groupings and CDI outcome. An epidemiologic assessment of hospitalized subjects harboring C. difficile isolates with ≤2 allelic differences, based on standard infection prevention and control assessment, revealed no evidence of person-to-person transmission. Interestingly, community-acquired CDI subjects in 40% of groups with ≤2 allelic differences resided within the same zip code. Among 18 subjects clinically classified as having recurrent CDI, WGS revealed 14 with initial and subsequent isolates differing by ≤2 allelic differences, suggesting a relapse of infection with the same initial strain, and 4 with isolates differing by >50 allelic differences, suggesting reinfection. Among the 5 subjects classified as having a reinfection based on the timing of recurrence, 3 had isolates with ≤2 allelic differences between them, suggesting a relapse, and 2 had isolates differing by >50 allelic differences, suggesting reinfection. Conclusions Our findings point to potential transmission of C. difficile in the community. WGS better differentiates relapse from reinfection than do definitions based on the timing of recurrence.

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