scholarly journals A narrative synthesis on the epidemiology of Clostridioides difficile

2021 ◽  
Vol 2 (2) ◽  
pp. 11-18
Author(s):  
Diana SPATARU ◽  
Angela PARASCHIV ◽  
Ion BERDEU
Keyword(s):  
Clostridium Difficile ◽  
Intestinal Flora ◽  
Risk Groups ◽  
High Morbidity ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Immunosuppressed Patients ◽  
Life Threatening ◽  
The Republic

Introduction. Clostridium difficile has been identified as the leading cause of antibiotic therapy-associated diarrhea and colitis, which has evolved from sporadic complications of antimicrobial therapy to severe, sometimes fatal events that have eventually become an endemic life-threatening issue among hospitalized and immunosuppressed patients worldwide. Material and methods. The analysis of the relevant bibliographic sources retrieved from the PubMed, Google Scholar, and other platforms was carried out. All the articles related to these research objectives were selected, followed by exclusion of articles focused on clinics and diagnosis. The study included 43 content-based relevant articles. This present article reveals the evolving epidemiology of C. difficile infection (CDI). Results. Clostridium difficile is a sporulated bacterium responsible for infectious diarrhea and pseudomembranous colitis, showing high morbidity and mortality rates among patients, especially in high-risk groups. C. difficile mainly affects hospitalized people over 65 years old, who have been exposed earlier to antibiotics. The risk factors for C. difficile in these individuals include depletion of the protective intestinal flora by antibiotics and a low immune response to C. difficile due to both advanced age and medical comorbidities. The major outbreaks commonly occur in health care, as well as in long-term care institutions. However, CDI is not supervised in the Republic of Moldova. Conclusions. A system for reporting and monitoring of C. difficile infection needs to be implemented in order to promptly and efficiently manage hospital outbreaks.

Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

2017 ◽  
Vol 26 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Anisha M. Fernandes ◽  
Maheshkumar M. Lakhe ◽  
Sanjay A. Pai
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Muscularis Propria ◽  
Immunocompromised Patients ◽  
Lymphoid Follicles ◽  
Negative Results ◽  
Immunosuppressed Patients ◽  
Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

scholarly journals 2044. An Assessment and Feedback Model Bringing Antimicrobial Stewardship Program Expertise to Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S687
Author(s):  
Philip Chung ◽  
Kate Tyner ◽  
Scott Bergman ◽  
Teresa Micheels ◽  
Mark E Rupp ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Rank Test ◽  
Post Intervention ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Care Facilities

Abstract Background Long-term care facilities (LTCF) often struggle with implementation of antimicrobial stewardship programs (ASP) that meet all CDC core elements (CE). The CDC recommends partnership with infectious diseases (ID)/ASP experts to guide ASP implementation. The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is an initiative funded by NE DHHS via a CDC grant to assist healthcare facilities with ASP implementation. Methods ASAP performed on-site baseline evaluation of ASP in 5 LTCF (42–293 beds) in the spring of 2017 using a 64-item questionnaire based on CDC CE. After interviewing ASP members, ASAP provided prioritized facility-specific recommendations for ASP implementation. LTCF were periodically contacted in the next 12 months to provide implementation support and evaluate progress. The number of CE met, recommendations implemented, antibiotic starts (AS) and days of therapy (DOT)/1000 resident-days (RD), and incidence of facility-onset Clostridioides difficile infections (FO-CDI) were compared 6 to 12 months before and after on-site visits. Paired t-test and Wilcoxon signed rank test were used for statistical analyses. Results Multidisciplinary ASP existed in all 5 facilities at baseline with medical directors (n = 2) or directors of nursing (n = 3) designated as team leads. Median CE implemented increased from 3 at baseline to 6 at the end of follow-up (P = 0.06). No LTCF had all 7 CE at baseline. By the end of one year, 2 facilities implemented all 7 CE with the remaining implementing 6 CE. LTCF not meeting all CE were only deficient in reporting ASP metrics to providers and staff. Among the 38 recommendations provided by ASAP, 82% were partially or fully implemented. Mean AS/1000 RD reduced by 19% from 10.1 at baseline to 8.2 post-intervention (P = 0.37) and DOT/1000 RD decreased by 21% from 91.7 to 72.5 (P = 0.20). The average incidence of FO-CDI decreased by 75% from 0.53 to 0.13 cases/10,000 RD (P = 0.25). Conclusion Assessment of LTCF ASP along with feedback for improvement by ID/ASP experts resulted in more programs meeting all 7 CE. Favorable reductions in antimicrobial use and CDI rates were also observed. Moving forward, the availability of these services should be expanded to all LTCFs struggling with ASP implementation. Disclosures All authors: No reported disclosures.

scholarly journals Household hygiene advice for patients with Clostridium difficile: Summary of hospital practice in Ontario, Canada

2019 ◽  
pp. 85-92
Author(s):  
Catherine Egan ◽  
Andria Jones-Bitton ◽  
Jan Sargeant ◽  
J Scott Weese
Keyword(s):  
Clostridium Difficile ◽  
Online Survey ◽  
Recurrent Infection ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Term Care ◽  
Healthcare Settings ◽  
Hospital Patients ◽  
Household Environment

Background: While Clostridium difficile infection is a significant concern in healthcare settings, there is increasing evidence that transmission does not solely occur in hospitals and long-term care homes. Hospital patients are regularly discharged home following or during treatment, and it is likely that many excrete spores into their household environment, posing risks of reinfection to themselves and transmission of spores to others. Hence, recommendations on household hygiene might be important for control of C. difficile. The objective of this study was to investigate the information provided by Ontario hospitals to patients who have laboratory-confirmed symptomatic C. difficile infection with respect to household hygiene advice once they are discharged from hospital. Methods: This cross-sectional study was conducted between January and August 2018 and included an anonymous online survey, a website scan of Ontario hospitals, and a content analysis of information provided to patients on discharge. The survey was distributed to practicing infection control professionals in Ontario hospitals through the IPAC Canada listserv. One response per hospital corporation was accepted. Results: Responses were obtained from 46/145 (32%) Ontario hospital corporations. The majority (30/46; 65%) of respondents indicated they personally believed the household environment was important or very important in the transmission of C. difficile. Almost half (22/46; 48%) of respondents reported that their hospital had a policy to provide household hygiene advice to patients when discharged home. However, analysis of 31 hospital information sheets from the website scan identified that 27/31 (88%) contained a statement that suggested there is little risk of transmission in households, and only 2/31 (6.5%) provided the specific dilution of bleach that is known to be sporicidal. Conclusion: The household hygiene advice provided by Ontario hospitals downplayed the likelihood of transmission of C. difficile spores in household environments and described a level of hygiene that is likely inadequate to prevent transmission of C. difficile spores in the home. This may contribute to recurrent infection and colonization of household contacts.

scholarly journals 2055. Action: A Year in the Lives of Consultant Pharmacists Working on Antimicrobial Stewardship in Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S692-S693
Author(s):  
Philip Chung ◽  
Alex Neukirch ◽  
Rebecca J Ortmeier ◽  
Scott Bergman ◽  
Mark E Rupp ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
First Generation ◽  
Long Term Care ◽  
Diagnostic Testing ◽  
Drug Regimen ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Care Facilities ◽  
Tract Infections

Abstract Background The CDC recommends consultant pharmacists (CP) support antimicrobial stewardship (AS) activities in long-term care facilities (LTCF) by reviewing antimicrobial appropriateness. We initiated a project training CP from a regional long-term care pharmacy to support AS implementation in LTCF. Methods CP were trained to evaluate the appropriateness of all systemic antimicrobial therapy (AT) and provide prescriber feedback during their monthly drug regimen review (DRR). An electronic database was developed to facilitate data reporting. Antimicrobial use (AU) and adverse events (AE) from 32 LTCF were analyzed for 2018 using descriptive statistics. Results A total of 5327 courses of AT with a median duration of 7 days (IQR 5–10) were reviewed. The majority of AT was started in the LTCF (55%) but was also initiated in hospitals (24%), clinics (11%) and emergency departments (2%). Of 2926 AT started in LTCF, 36% were based on nurse evaluation (NE) while 33% began after prescriber evaluation (PE). Fluoroquinolones (FQ) and first-generation cephalosporins were the most commonly prescribed agents (Table 1). Treatment or prophylaxis of urinary tract infections accounted for 40% of AU (Figure 1). Diagnostic testing was associated with 37% of AT courses. Urine cultures were the most frequent test performed (81%). Overall, 41% of AT was determined to be inappropriate resulting in > 800 feedback letters sent to prescribers. Unnecessary antibiotic starts (based on revised Mc Geer or Loeb’s criteria) were identified as the most common reason (Figure 2). AT appropriateness varied depending on the setting in which it was initiated. A majority (87%) of AT initiated in hospitals was found to be appropriate with 56% and 46% appropriate for ED and clinic starts. Appropriateness of LTCF initiated AT was 49% (59% after PE and 42% after NE). AE were associated with 3% of AT with allergic reactions and Clostridioides difficile infections occurring with 0.4% and 0.7% of AT, respectively. AE were most frequently associated with folate antagonists (5%) and FQ (3%). Conclusion This study demonstrates many AU improvement opportunities exist in LTCF and CP can play an important role in identifying them if trained in AS principles. CP should review all AU for appropriateness and provide data to inform AS efforts in LTCF. Disclosures All authors: No reported disclosures.

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