Clostridium difficile infection in patients hospitalized in the gastroenterology ward – retrospective analysis

2018 ◽  
Vol 90 (1) ◽  
pp. 7-12
Author(s):  
Kinga Podlaszewska ◽  
Ewa Małecka‑Panas ◽  
Anita Gąsiorowska
Keyword(s):  
Clostridium Difficile ◽  
Retrospective Analysis ◽  
Clostridium Difficile Infection ◽  
Clinical Course ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Medical Documentation ◽  
Hospitalization Period ◽  
Future Outbreak

INTRODUCTION. Clostridium difficile associated colitis became over last years a worldwide medical issue. It involves patients of the Polish hospitals too. The aim of the study was the analysis of CDAD incidence and the course of infection in Gastroenterology Ward of Regional Specialist Hospital of Zgierz, 2012-2015. MATERIAL AND METHODS. Retrospective analysis of the medical documentation of 79 patients with CDAD was performed. Demographic and epidemiological data and the clinical course of infection were analyzed. RESULTS. The study group comprised of women in 59,5% and men in 40,5%. The patients’ average age was 70,5 years. The average hospitalization period was 10,3 days. CDAD infection seasonality was proved, with statistically significant peak in springtime. 73% of patients were previously hospitalized and 85% - had co-morbidities. 76% of patients underwent antibiotherapy, whilst 29% - used PPI prior to CDAD diagnosis. 50,6% of patients had severe CDAD diagnosed. The recurrence reached 14%. In 19% of patients CDAD resulted in death. DISCUSSION. The results of the study confirm increase of the incidence of the patients with CDAD in Gastroenterology Ward over 4-years’ observation. The prevalence was higher among 65+ patients, after prior hospitalization and antibiotherapy. The co-morbidities was a significant risk factor, especially common in severe cases. CONCLUSION. The results we obtained confirm substantial importance of Clostridium difficile infection leading to antibiotherapy- associated diarrhea among adults, causing prolonged hospitalization, increased prevalence and mortality of patients. Getting to know and minimizing the risk factors will prevent the future outbreak of the disease.

Implementation of Global Strategies to Prevent Hospital-Onset Clostridium difficile Infection: Targeting Proton Pump Inhibitors and Probiotics

2017 ◽  
Vol 51 (10) ◽  
pp. 848-854 ◽  
Author(s):  
Paul O. Lewis ◽  
Timothy S. Lundberg ◽  
Jennifer L. Tharp ◽  
Clay W. Runnels
Keyword(s):  
Cohort Study ◽  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clostridium Difficile Infection ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Order Sets ◽  
Global Strategies

Background: Proton pump inhibitors (PPIs) have been identified as a significant risk factor for the development of Clostridium difficile infection (CDI). Probiotics given concurrently with antibiotics have been shown to have a moderate impact on preventing CDI. Objective: To evaluate the effectiveness of hospital-wide interventions designed to reduce PPI use and increase probiotics and whether these interventions were associated with a change in the incidence of hospital onset (HO)-CDI. Methods: This retrospective cohort study compared 2 fiscal years: July 2013 to June 2014 (FY14) and July 2014 to June 2015 (FY15). In July of FY15, global educational initiatives were launched targeting PPIs. Additionally, a HO-CDI prevention bundle was added to antibiotic-containing order sets targeting probiotics. Overall PPI use, probiotic use, and incidence of HO-CDI were recorded and compared for each cohort. Charts were also reviewed for patients who developed HO-CDI for the presence and appropriateness of a PPI and presence of probiotics. Results: The interventions resulted in a decrease in PPI use by 14% or 96 doses/1000 patient days (TPD; P = 0.0002) and a reduction in IV PPI use by 31% or 71 doses/TPD ( P = 0.0008). Probiotic use increased by 130% or 126 doses/TPD ( P = 0.0006). The incidence of HO-CDI decreased by 20% or 0.1 cases/TPD ( P = 0.04). Conclusions: A collaborative, multifaceted educational initiative directed at highlighting the risks associated with PPI use was effective in reducing PPI prescribing. The implementation of a probiotic bundle added to antibiotic order sets was effective in increasing probiotic use. These interventions were associated with a decrease in incidence of HO-CDI.

scholarly journals Mo1523 – Nash Cirrhosis is a Significant Risk Factor for Recurrent Clostridium Difficile Infection in Hospitalized Patients with Cirrhosis

2019 ◽  
Vol 156 (6) ◽  
pp. S-1329-S-1330
Author(s):  
Parkpoom Phatharacharukul ◽  
Russell D. Purpura ◽  
Devika Gandhi ◽  
Huiping Xu ◽  
Katie Bickett-Burkhart ◽  
...  
Keyword(s):  
Risk Factor ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Hospitalized Patients ◽  
Recurrent Clostridium Difficile Infection

scholarly journals IMPLICATIONS OF ANTIBIOTHERAPY IN CLOSTRIDIUM DIFFICILE INFECTION TO HOSPITALIZED PATIENTS IN DOLJ COUNTY (ROMANIA)

2017 ◽  
Vol 20 (2) ◽  
pp. 75-79
Author(s):  
Livia Dragonu ◽  
◽  
Augustin Cupsa ◽  
Irina Niculescu ◽  
Lucian Giubelan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Antibiotic Treatment ◽  
Clostridium Difficile Infection ◽  
Gastrointestinal Surgery ◽  
Significant Risk ◽  
Significant Risk Factor

Objectives. The paper presents the role of the antibiotic treatment and of the favoring factors independent on the antibiotherapy, identified in the occurrence of Clostridium difficile infection (CDI) in hospitalized cases in Dolj County. Material and method. Two groups of patients were analyzed: the CDI AB group (178 cases of CDI that received antibiotic treatment) and the CDI non AB group (36 CDI cases which did not receive antibiotic treatment) recorded between July 2014 and December 2016). Results. The antibiotherapy was a significant risk factor, registered at 83.2% of the cases. The classes of antibiotics associated with the onset of CDI were cephalosporins (73.5% of cases), quinolones (24.2%), penicillins (13.4%), tuberculostatics (6.1%), carbapenems (5.6%). The cases came from the general surgery sections (25.2%), pneumophtiziology (16.8%), intensive care (13.5%), neurology (12.1%), nephrology (6.1%), orthopedics (6.1%), cardiology (4.2%), plastic surgery (4.2%), urology (3.7%). CDI non AB recorded a higher percentage compared to CDI AB in the Intensive care sections (30.6% versus10.1%). The comparative analysis of the characteristics of the patients with CDI AB and CDI non AB did not reveal significant differences linked to the age, sex, interval between admission and onset of the symptoms, recent gastrointestinal surgery or taking antacids. Conclusions. The antibiotherapy is an important risk factor for CDI, cephalosporins and quinolones being frequently-involved. Being admitted to the intensive care unit and the severity of the underlying conditions had a significant role in the appearance of CDI in patients without exposure to antibiotics.

scholarly journals Neisseria meningitidis carriage and risk factors among teenagers in Suizhou city in China

2020 ◽  
Vol 148 ◽  
Author(s):  
Fei He ◽  
Hong mei Yang ◽  
Guo ming Li ◽  
Bing qing Zhu ◽  
Yating Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Density ◽  
Neisseria Meningitidis ◽  
Old Age ◽  
Age Groups ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Carriage Rate

Abstract Teenagers are important carriers of Neisseria meningitidis, which is a leading cause of invasive meningococcal disease. In China, the carriage rate and risk factors among teenagers are unclear. The present study presents a retrospective analysis of epidemiological data for N. meningitidis carriage from 2013 to 2017 in Suizhou city, China. The carriage rates were 3.26%, 2.22%, 3.33%, 3.53% and 9.88% for 2013, 2014, 2015, 2016 and 2017, respectively. From 2014 to 2017, the carriage rate in the 15- to 19-year-old age group (teenagers) was the highest and significantly higher than that in remain age groups. Subsequently, a larger scale survey (December 2017) for carriage rate and relative risk factors (population density, time spent in the classroom, gender and antibiotics use) were investigated on the teenagers (15- to 19-year-old age) at the same school. The carriage rate was still high at 33.48% (223/663) and varied greatly from 6.56% to 52.94% in a different class. Population density of the classroom was found to be a significant risk factor for carriage, and 1.4 persons/m2 is recommended as the maximum classroom density. Further, higher male gender ratio and more time spent in the classroom were also significantly associated with higher carriage. Finally, antibiotic use was associated with a significantly lower carriage rate. All the results imply that attention should be paid to the teenagers and various measures can be taken to reduce the N. meningitidis carriage, to prevent and control the outbreak of IMD.

Physiological Exophoria Did Not Increase The Incidence of Myopia in Rural School Children in Taiwan

2021 ◽  
Author(s):  
Jui-Hung Hsu ◽  
Li-Ju Lai ◽  
Tao-Hsin Tung ◽  
Wei-Hsiu Hsu
Keyword(s):  
Elementary School ◽  
Logistic Regression ◽  
Elementary School Students ◽  
Multinomial Logistic Regression ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Categorical Variables ◽  
School Students

Abstract Purpose:This study evaluated the incidence rate and risk factors for developing myopia in elementary school students in Chiayi, Taiwan.Methods:This prospective cohort study comprised 1816 students without myopia (grades 1 to 5 in Chiayi County). The students underwent a noncycloplegic ocular alignment examinations using an autorefractometer and completed a questionnaires at baseline and at a 1-year follow-up. A univariate logistic regression was used to assess the effects of the categorical variables on new cases of myopia. A multinomial logistic regression was then conducted. A chi-squared test was used to compare new cases of myopia in terms of ocular alignment. A Cox hazard ratio model was then used to validate factors associated with changes in ocular alignment. A P value of <.05 was considered significant.Results: In 370 participants with new cases of myopia out of 1816 participants, a spherical error of −1.51 ± 0.6 diopters was noted at follow-up. The baseline ocular alignment was not a significant risk factor for developing myopia (exophoria vs orthophoria: OR 1.26, 95% CI 0.97-1.62; other vs. orthophoria: OR 1.15, 95% CI 0.73-1.82). However, new cases of myopia (HR 1.36, 95% CI 1.14-1.61), and baseline ocular alignment (exophoria vs orthophoria: HR 3.76, 95% CI 3.20-4.42; other vs orthophoria: HR 3.02, 95% CI 2.05-4.45) were associated with exophoria at follow-up.Conclusions: This study provided epidemiological data on the incidence of myopia in elementary school students in Chiayi, Taiwan. It also demonstrated that physiological exophoria does not predispose patients to developing myopia.

scholarly journals The Analysis of Risk Factors and Clinical-Demographic Characteristics of Patients with Clostridium Dificille Infection as Well as The Outcome of Their Treatment

2016 ◽  
Vol 17 (2) ◽  
pp. 139-144
Author(s):  
Ivana Raković ◽  
Biljana Popovska Jovicic ◽  
Andriana Bukonjic ◽  
Sara Petrovic ◽  
Petar Canovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antibiotic Use ◽  
Demographic Characteristics ◽  
Medical Documentation ◽  
Hospital Treatment ◽  
Continuous Variables ◽  
Bacterial Strains ◽  
H2 Blockers

Abstract Pseudomembranous colitis is a frequent nosocomial infection associated with significant morbidity and mortality. Clostridium difficile infection incidence most frequently increases due to unreasonable antibiotic use and the appearance of new hypervirulent bacterial strains, which leads to prolonged hospitalization and an increase in the total cost of hospital treatment.This is a retrospective design study conducted at Clinical Centre Kragujevac from January to December 2014. The patient data were obtained from the protocol of the Virological Laboratory and from medical documentation. All statistical analyses were performed using the computer program SPSS. The descriptive statistical data are expressed as percentage values. Continuous variables are expressed as the arithmetic mean with the standard deviation.Clostridium difficile infection occurred more frequently with elderly patients (123 patients were over 65 years old). Out of 154 patients on antibiotic treatment, 110 patients were treated with a combination of two or more antibiotics from different pharmacological groups. The most represented antibiotics were from the cephalosporin (71.4%) and quinolone (46.3%) groups. A total of 85.8% of the patients used proton pump inhibitors and H2 blockers.Our results describe the clinical and demographic characteristics of patients with diagnosed Clostridium difficile infection. The most prevalent characteristics (age, antibiotic therapy, PPI and H2 blocker use), which other researchers have also mentioned as risk factors, were present in our study as well.

scholarly journals 2025. Evaluation of the Impact of an Antimicrobial Stewardship Program in a Tertiary Hospital in Northern Italy: Efficacy of a Persuasive Approach on Antibiotics Consumption and Rate of Clostridium difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S679-S680
Author(s):  
Erika Chiari ◽  
Davide Mangioni ◽  
Ester Pollastri ◽  
Liana Signorini ◽  
Giovanni Moioli ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Epidemiological Data ◽  
Tertiary Hospital ◽  
Northern Italy ◽  
Stewardship Program ◽  
Bed Days ◽  
The Impact

Abstract Background Antimicrobial resistance (AMR) situation in Italian hospitals and regions represents a major public health threat [ECDC, 2017]. Antimicrobial stewardship programs (ASPs), particularly when based on local epidemiology, have been beneficial in optimizing antibiotic therapy as well as reducing hospital rates of Clostridium difficile infection (CDI) and AMR [Akpan MR, Antibiotics 2016].. Methods Our ASP program has been conducted at Spedali Civili General Hospital of Brescia, Northern Italy (1300-bed tertiary hospital), between the beginning of 2016 and the end of 2017. A preliminary analysis of local epidemiological data was performed (Table 1). Seven groups (“districts”) were identified according to microbiological and clinical similarities. This was a persuasive-based ASP. First, we trained physicians on general principles of AS, then guidelines for the management of “difficult-to-handle” infections were drafted based on international guidelines and local microbiological data (Table 2).. Results Here we show the results of pre-ASP (2015) vs. post-ASP (2018) analysis on antibiotic consumption (AC) and CDI rates. AC is expressed in DDD/100 bed-days. The overall hospital AC decreased from 84.31 to 76.84 (−9%), consistently with national recommendations [Italian National Plan against AMR, 2017]. In accordance with the local guidelines developed within our ASP, carbapenem consumption decreased from 5.77 to 4.87 (−16%) and fluoroquinolones (FLQ) from 14.45 to 9.94 (−31%). At the same time piperacillin/tazobactam use increased from 5.53 to 8.46 (53%). 3°–4°G cephalosporins and glycopeptides consumption slightly reduced from 11.78 to 11.42 (−3%) and from 4.07 to 3.83 (−6%), respectively. AC of the different districts involved is reported in Table 3. CDI rates decreased from 0.0434/100 bed-days in 2015 to 0.0315/100 bed-days in 2018 (−27%) (Figure 1). Conclusion Our ASP was a persuasive-based program in a setting of high AMR rates. In the short term, it has shown a positive impact in improving AC (in particular of broad-spectrum antibiotics with a high risk of resistance selection and CDI) and CDI rates. Audits for local guidelines adherence and the evaluation of AC, AMR and CDI rates are ongoing as long-term quality measures for assessing the impact of our ASP. Disclosures All authors: No reported disclosures.

scholarly journals Gastrointestinal carriage is a major reservoir of K. pneumoniae infection in intensive care patients

2016 ◽  
Author(s):  
Claire L Gorrie ◽  
Mirjana Mirceta ◽  
Ryan R Wick ◽  
David J Edwards ◽  
Richard A Strugnell ◽  
...  
Keyword(s):  
Intensive Care ◽  
Human Microbiome ◽  
Significant Risk ◽  
Clinical Information ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Opportunistic Pathogen ◽  
Healthy Human ◽  
Icu Patients ◽  
Gut Colonization

AbstractBackgroundKlebsiella pneumoniae is an opportunistic pathogen and a leading cause of hospital-associated (HA) infections. Patients in intensive care units (ICUs) are particularly at risk, and outbreaks are frequently reported in ICUs. K. pneumoniae is also part of the healthy human microbiome, providing a potential reservoir for HA infection. However, the frequency of K. pneumoniae gut colonization and its contribution to HA infections are not well characterized.MethodsWe conducted one-year prospective cohort study of ICU patients. Participants (n=498) were screened for rectal and throat carriage of K. pneumoniae shortly after admission, and clinical information was extracted from hospital records.K. pneumoniae isolated from screening swabs and clinical diagnostic samples were characterized using whole genome sequencing. Genomic and epidemiological data were combined to identify likely transmission events.Results and ConclusionsK. pneumoniae carriage frequencies were estimated at 6% (95% CI, 3%-8%) amongst ICU patients admitted direct from the community, and 19% (95% CI, 14% – 51%) amongst those who had recent contact with healthcare. Gut colonisation on admission was significantly associated with subsequent K. pneumoniae infection (infection risk 16% vs 3%, OR=6.9, p<0.001), and genome data indicated a match between carriage and infection isolates in most patients. Five likely transmission chains were identified, resulting in six infections (12% of K. pneumoniae infections in ICU). In contrast, 49% of K. pneumoniae infections were caused by a strain that was unique to the patient, and 48% of patients with K. pneumoniae infections who participated in screening were positive for prior colonisation. These data confirm K. pneumoniae colonisation is a significant risk factor for subsequent infection in ICU, and indicate that half of all K. pneumoniae infections result from patients’ own microbiota. Screening for colonisation on admission could limit risk of infection in the colonised patient and others.

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