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Penit A, Bemer P, Besson J, Cazet L, Bourigault C, Juvin ME, Fix MH, Bruley des Varannes S, Boutoille D, Batard E, Lepelletier D. Community-acquired Clostridium difficile infections. Med Mal Infect 2016; 46:131-9. [PMID: 27039068 DOI: 10.1016/j.medmal.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/25/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the management and treatment of community-acquired C. difficile infections (CDI) and to evaluate family physicians' (FP) knowledge and practice. PATIENTS AND METHODS Observational study from December 2013 to June 2014. All community-acquired CDI case patients diagnosed in the community or at the University Hospital of Nantes were prospectively included. A questionnaire was mailed to 150 FPs of the area of Nantes. RESULTS A total of 27 community-acquired CDI case patients were included (incidence: 7.7 case patients/100,000 inhabitants). Mean age was higher among case patients diagnosed at hospital (69years) compared with those diagnosed in the community (44years). Fifteen patients were treated at home (55%) and 22 received a first-line treatment with metronidazole. Only one patient did not receive any prior antibiotic treatment. Amoxicillin-clavulanic acid was mainly prescribed (68%) for respiratory and ENT infections (40%). Twenty-three patients were cured on Day 7 and three had complications (two deaths). Thirty-one of 47 FPs reported to have already managed CDI patients. Twenty-two FPs reported to usually treat patients with uncomplicated CDI at home, 21 to refer patients to a specialist, and three to hospital. Forty-one FPs reported to prescribe a CD toxin test only after recent antibiotic exposure and 30 when patients are at risk of CDI. CONCLUSION The incidence and impact of community-acquired CDIs may be underestimated and the unjustified use of antibiotics may promote their emergence. FPs are not used to treat CDIs as more than 50% prefer referring patients to hospital or to a specialist.
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Affiliation(s)
- A Penit
- Pôle de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | - P Bemer
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - J Besson
- Laboratoire d'analyses médicales Biolance, 44000 Nantes, France
| | - L Cazet
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - C Bourigault
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - M-E Juvin
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France
| | - M-H Fix
- Pôle de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | | | - D Boutoille
- Service des maladies infectieuses et tropicales, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France
| | - E Batard
- Service d'accueil des urgences, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France
| | - D Lepelletier
- Service de bactériologie-hygiène hospitalière, CHU de Nantes, 44093 Nantes, France; UPRES EA 3826, UFR médecine, université de Nantes, 44035 Nantes, France.
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Tian TT, Zhao JH, Yang J, Qiang CX, Li ZR, Chen J, Xu KY, Ciu QQ, Li RX. Molecular Characterization of Clostridium difficile Isolates from Human Subjects and the Environment. PLoS One 2016; 11:e0151964. [PMID: 27011211 PMCID: PMC4807052 DOI: 10.1371/journal.pone.0151964] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/07/2016] [Indexed: 01/05/2023] Open
Abstract
Clostridium difficile is a spore-forming, gram-positive, anaerobic bacillus that can cause C. difficile infection (CDI). However, only a few studies on the prevalence and antibiotic resistance of C. difficile in healthy individuals in China have been reported. We employed a spore enrichment culture to screen for C. difficile in the stool samples of 3699 healthy Chinese individuals who were divided into 4 groups: infants younger than 2 years of age and living at home with their parents; children aged 1 to 8 years of age and attending three different kindergarten schools; community-dwelling healthy adult aged 23-60 years old; and healthcare workers aged 28-80 years old. The C. difficile isolates were analyzed for the presence of toxin genes and typed by PCR ribotyping and multilocus sequence typing (MLST). The minimum inhibitory concentration of 8 antimicrobial agents was determined for all of the isolates using the agar dilution method. The intestinal carriage rate in the healthy children was 13.6% and ranged from 0% to 21% depending on age. The carriage rates in the 1654 community-dwelling healthy adults and 348 healthcare workers were 5.5% and 6.3%, respectively. Among the isolates, 226 were toxigenic (225 tcdA+/tcdB+ and 1 tcdA+/tcdB+ ctdA+/ctdB+). Twenty-four ribotypes were found, with the dominant type accounting for 29.7% of the isolates. The toxigenic isolates were typed into 27 MLST genotypes. All of the strains were susceptible to vancomycin, metronidazole, fidaxomicin, and rifaximin. High resistance to levofloxacin and ciprofloxacin at rates of 39.8% and 98.3%, respectively, were observed. ST37 isolates were more resistant to levofloxacin than the other STs. The PCR ribotypes and sequence types from the healthy populations were similar to those from the adult patients.
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Affiliation(s)
- Tian-tian Tian
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
| | - Jian-hong Zhao
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
- * E-mail:
| | - Jing Yang
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
| | - Cui-xin Qiang
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
| | - Zhi-rong Li
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
| | - Jing Chen
- Health Care Department, Maternal and Child Health Care Center of Cangzhou, Cangzhou City, Hebei Province, China
| | - Kai-yue Xu
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
| | - Qing-qing Ciu
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
| | - Ru-xin Li
- Department of Clinical Microbiology, Second Hospital of Hebei Medical University, Hebei Provincial Center for Clinical Laboratories, Shijiazhuang City, Hebei Province, China
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Bandelj P, Blagus R, Briski F, Frlic O, Vergles Rataj A, Rupnik M, Ocepek M, Vengust M. Identification of risk factors influencing Clostridium difficile prevalence in middle-size dairy farms. Vet Res 2016; 47:41. [PMID: 26968527 PMCID: PMC4788955 DOI: 10.1186/s13567-016-0326-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022] Open
Abstract
Farm animals have been suggested to play an important role in the epidemiology of Clostridium difficile infection (CDI) in the community. The purpose of this study was to evaluate risk factors associated with C. difficile dissemination in family dairy farms, which are the most common farming model in the European Union. Environmental samples and fecal samples from cows and calves were collected repeatedly over a 1 year period on 20 mid-size family dairy farms. Clostridium difficile was detected in cattle feces on all farms using qPCR. The average prevalence between farms was 10% (0–44.4%) and 35.7% (3.7–66.7%) in cows and calves, respectively. Bacterial culture yielded 103 C. difficile isolates from cattle and 61 from the environment. Most C. difficile isolates were PCR-ribotype 033. A univariate mixed effect model analysis of risk factors associated dietary changes with increasing C. difficile prevalence in cows (P = 0.0004); and dietary changes (P = 0.004), breeding Simmental cattle (P = 0.001), mastitis (P = 0.003) and antibiotic treatment (P = 0.003) in calves. Multivariate analysis of risk factors found that dietary changes in cows (P = 0.0001) and calves (P = 0.002) increase C. difficile prevalence; mastitis was identified as a risk factor in calves (P = 0.001). This study shows that C. difficile is common on dairy farms and that shedding is more influenced by farm management than environmental factors. Based on molecular typing of C. difficile isolates, it could also be concluded that family dairy farms are currently not contributing to increased CDI incidence.
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Affiliation(s)
- Petra Bandelj
- Veterinary faculty, University of Ljubljana, cesta v Mestni log 47, 1115, Ljubljana, Slovenia.
| | - Rok Blagus
- Institute for biostatistics and Medical informatics, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
| | | | - Olga Frlic
- , Vinharje 6, 4223, Poljane nad Skofjo Loko, Slovenia
| | | | - Maja Rupnik
- National Laboratory for Health, Environment and Food, Prvomajska ulica 1, 2000, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia.,Centre of Excellence for Integrated Approaches in Chemistry and Biology of Proteins, Jamova cesta 39, 1000, Ljubljana, Slovenia
| | - Matjaz Ocepek
- Veterinary faculty, University of Ljubljana, cesta v Mestni log 47, 1115, Ljubljana, Slovenia
| | - Modest Vengust
- Veterinary faculty, University of Ljubljana, cesta v Mestni log 47, 1115, Ljubljana, Slovenia
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104
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Sentinel community Clostridium difficile infection (CDI) surveillance in Scotland, April 2013 to March 2014. Anaerobe 2016; 37:49-53. [DOI: 10.1016/j.anaerobe.2015.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/04/2015] [Accepted: 12/15/2015] [Indexed: 02/04/2023]
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105
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Goldstein EJC, Johnson S, Maziade PJ, McFarland LV, Trick W, Dresser L, Millette M, Mazloum H, Low DE. Pathway to Prevention of Nosocomial Clostridium difficile Infection. Clin Infect Dis 2016; 60 Suppl 2:S148-58. [PMID: 25922401 DOI: 10.1093/cid/civ142] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To address the significant morbidity and mortality rates associated with nosocomial Clostridium difficile-associated diarrhea (CDAD), a series of recommendations and a pathway to prevention were developed. METHODS An expert panel of infectious disease (ID) specialists participated in a modified Delphi process with specific objectives: (1) conduct a review for CDAD and prevention; (2) develop statements based upon panel members' opinions; (3) hold a panel meeting during the 2012 IDWeek; and (4) review the final recommendations and prevention pathway prior to submission for publication. RESULTS The panel voted on (1) antibiotic stewardship (7 of 8 panelists); (2) reduction of other potentially modifiable risk factors (variable); (3) utilization of specific probiotics to prevent C. difficile overgrowth (8/8); (4) staff education regarding CDAD preventive measures (8/8); (5) appropriate hand hygiene for everyone (7/8); (6) environmental cleaning (8/8); (7) medical equipment disinfection (7/8); (8) early detection of CDAD in symptomatic patients (7/8); (9) usage of protective clothing/gloves (8/8); (10) proper measures during outbreak (8/8); and (11) surveillance to monitor efficacy data of preventive measures (8/8). CONCLUSIONS The panel members agreed with 11 of 17 recommendations presented. The additional recommendations by the panel were proton pump inhibitor use as a risk factor and the use of adjunctive therapy with specific probiotic, as it was approved by Health Canada for the risk reduction of CDAD in hospitalized patients.
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Affiliation(s)
- Ellie J C Goldstein
- RM Alden Research Laboratory and the David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Stuart Johnson
- Hines VA Hospital and Loyola University Medical Center, Chicago, Illinois
| | | | - Lynne V McFarland
- Department of Medicinal Chemistry, University of Washington, Seattle
| | | | - Linda Dresser
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario
| | | | | | - Donald E Low
- Mount Sinai Hospital, University of Toronto, Ontario, Canada
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106
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Almeida R, Gerbaba T, Petrof EO. Recurrent Clostridium difficile infection and the microbiome. J Gastroenterol 2016; 51:1-10. [PMID: 26153514 DOI: 10.1007/s00535-015-1099-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 02/04/2023]
Abstract
The diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. As our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (FMT) and microbial ecosystem therapeutics (MET) for a variety of diseases. The potential role of FMT and MET in the treatment of Clostridium difficile infection (CDI)-currently the leading nosocomial gastrointestinal infection-has proven highly effective for recurrent CDI, and has emerged as a paradigm shift in the treatment of this disease. The current review will serve as a summary of the key aspects of CDI, and will introduce the essential framework and challenges of FMT, as is currently practiced. MET represents the progression of conventional bacteriotherapy that fundamentally capitalizes on the restorative properties of intestinal bacterial communities and may be viewed as the culmination of a rationally designed therapeutic modality. As our understanding of the composition and function of the intestinal microbiota evolves, it will likely drive next-generation microbiota therapies for a range of medical conditions, such as inflammatory bowel disease, obesity, and metabolic syndrome.
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Affiliation(s)
- Rowena Almeida
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Teklu Gerbaba
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Elaine O Petrof
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, ON, Canada. .,Department of Medicine/ Division of Infectious Diseases, Queen's University, 76 Stuart Street, GIDRU Wing, Kingston, ON, K7L 2V7, Canada.
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107
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Falcone M, Russo A, Iraci F, Carfagna P, Goldoni P, Vullo V, Venditti M. Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection. Antimicrob Agents Chemother 2016; 60:252-7. [PMID: 26482315 PMCID: PMC4704211 DOI: 10.1128/aac.01927-15] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/15/2015] [Indexed: 01/25/2023] Open
Abstract
We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI(+)) and those with CDI and no evidence of primary BSI (CDI/BSI(-)). Data about clinical features, microbiology, treatments, and mortality were obtained. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI, while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis, ribotype 027 status (odds ratio [OR], 6.5), CDI recurrence (OR, 5.5), severe CDI infection (OR, 8.3), and oral vancomycin at >500 mg/day (OR, 3.1) were recognized as factors independently associated with the development of nosocomial BSI. Thirty-day mortality from CDI diagnosis was higher for patients of the CDI/BSI(+) group than for the controls (38.9 versus 13.1%; P < 0.001). Among patients of the CDI/BSI(+) group, mortality attributable to primary BSI was as high as 57%. Our findings suggest that severe CDI is complicated by the development of nosocomial BSI. Candida species and enteric bacteria appear to be the leading causative pathogens and are associated with poor outcomes.
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Affiliation(s)
- Marco Falcone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Iraci
- Faculty of Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Paola Goldoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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108
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Postma N, Kiers D, Pickkers P. The challenge of Clostridium difficile infection: Overview of clinical manifestations, diagnostic tools and therapeutic options. Int J Antimicrob Agents 2015; 46 Suppl 1:S47-50. [DOI: 10.1016/j.ijantimicag.2015.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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109
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Hussain I, Sharma R, Borah P, Rajkhowa S, Hussain I, Barkalita L, Hasin D, Choudhury M, Rupnik M, Deka N, Saikia G. Isolation and characterization of Clostridium difficile from pet dogs in Assam, India. Anaerobe 2015; 36:9-13. [DOI: 10.1016/j.anaerobe.2015.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/07/2015] [Accepted: 09/17/2015] [Indexed: 11/25/2022]
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110
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Ticinesi A, Nouvenne A, Folesani G, Prati B, Morelli I, Guida L, Turroni F, Ventura M, Lauretani F, Maggio M, Meschi T. Multimorbidity in elderly hospitalised patients and risk of Clostridium difficile infection: a retrospective study with the Cumulative Illness Rating Scale (CIRS). BMJ Open 2015; 5:e009316. [PMID: 26503394 PMCID: PMC4636642 DOI: 10.1136/bmjopen-2015-009316] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To identify the role of chronic comorbidities, considered together in a literature-validated index (Cumulative Illness Rating Scale, CIRS), and antibiotic or proton-pump inhibitor (PPI) treatments as risk factors for hospital-acquired Clostridium difficile infection (CDI) in elderly multimorbid hospitalised patients. DESIGN Retrospective cohort study. SETTING Subacute hospital geriatric care ward in Italy. PARTICIPANTS 505 (238 male (M), 268 female (F)) elderly (age≥65) multimorbid patients. MAIN OUTCOME MEASURES The relationship between CDI and CIRS Comorbidity Score, number of comorbidities, antibiotic, antifungal and PPI treatments, and length of hospital stay was assessed through age-adjusted and sex-adjusted and multivariate logistic regression models. The CIRS Comorbidity Score was handled after categorisation in quartiles. RESULTS Mean age was 80.7±11.3 years. 43 patients (22 M, 21 F) developed CDI. The prevalence of CDI increased among quartiles of CIRS Comorbidity Score (3.9% first quartile vs 11.1% fourth quartile, age-adjusted and sex-adjusted p=0.03). In the multivariate logistic regression analysis, patients in the highest quartile of CIRS Comorbidity Score (≥17) carried a significantly higher risk of CDI (OR 5.07, 95% CI 1.28 to 20.14, p=0.02) than patients in the lowest quartile (<9). The only other variable significantly associated with CDI was antibiotic therapy (OR 2.62, 95% CI 1.21 to 5.66, p=0.01). PPI treatment was not associated with CDI. CONCLUSIONS Multimorbidity, measured through CIRS Comorbidity Score, is independently associated with the risk of CDI in a population of elderly patients with prolonged hospital stay.
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Affiliation(s)
- Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Antonio Nouvenne
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | | | - Beatrice Prati
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Ilaria Morelli
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Loredana Guida
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
| | - Francesca Turroni
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy
| | - Marco Ventura
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy
| | | | - Marcello Maggio
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Parma University Hospital, Parma, Italy
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Mori N, Aoki Y. Clinical characteristics and risk factors for community-acquired Clostridium difficile infection: A retrospective, case-control study in a tertiary care hospital in Japan. J Infect Chemother 2015; 21:864-7. [PMID: 26482373 DOI: 10.1016/j.jiac.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 12/15/2022]
Abstract
The epidemiology of Clostridium difficile infection (CDI) has changed in the past decade. The incidence, prevalence, and severity of community-acquired CDI (CA-CDI) have increased. However, the epidemiology of CA-CDI in Japan has not been investigated. To evaluate the clinical characteristics and risk factors for CA-CDI in Japan, we conducted a retrospective, case-control study of CA-CDI at the National Hospital Organization Tokyo Medical Center between January 2010 and December 2014. Two age- and sex-matched C. difficile toxin- and culture-negative controls were assigned for each case. A total of 26 patients were identified with CA-CDI were identified. The incidence rate for CA-CDI was 1.4 per 100,000 patient-years. Of the CA-CDI patients, 6 (23.1%) had no underlying comorbidity, 22 (84.6%) had prior exposure to antimicrobials, and 5 (19.2%) had prior exposure to antacids. Although 5 patients (19.2%) required hospitalization, none required intensive care or died. Recurrence was observed in 1 patient (3.8%). Patients with CA-CDI cases were more likely to have been recently exposed to antimicrobials compared to controls (odds ratio [OR]: 8.12, 95% confidence interval [CI]: 2.43-26.98). However, exposure to antacids was not associated with CA-CDI (OR: 0.59, 95% CI: 0.19-1.85). Our findings indicate that the incidence rate for CA-CDI in Japan is relatively low compared to the US and Europe, and that CA-CDI is usually not severe. Previous antimicrobial exposure was the main risk factor for CA-CDI, suggesting that clinicians should consider CDI in patients presenting with diarrhea who have recently received antimicrobials.
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Affiliation(s)
- Nobuaki Mori
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Japan.
| | - Yasuko Aoki
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Japan
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112
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Boyle NM, Magaret A, Stednick Z, Morrison A, Butler-Wu S, Zerr D, Rogers K, Podczervinski S, Cheng A, Wald A, Pergam SA. Evaluating risk factors for Clostridium difficile infection in adult and pediatric hematopoietic cell transplant recipients. Antimicrob Resist Infect Control 2015; 4:41. [PMID: 26473030 PMCID: PMC4606905 DOI: 10.1186/s13756-015-0081-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/29/2015] [Indexed: 12/18/2022] Open
Abstract
Background Although hematopoietic cell transplant (HCT) recipients are routinely exposed to classic risk factors for Clostridium difficile infection (CDI), few studies have assessed CDI risk in these high-risk patients, and data are especially lacking for pediatric HCT recipients. We aimed to determine incidence and risk factors for CDI in adult and pediatric allogeneic HCT recipients. Methods CDI was defined as having diarrhea that tested positive for C. difficile via PCR, cytotoxin assay, or dual enzyme immunoassays. We included all patients who received an allogeneic HCT from 2008 to 2012 at the Fred Hutchinson Cancer Research Center; those <1 year old or with CDI within 8 weeks pre-HCT were excluded. Patients were categorized by transplanting hospital (“adult” or “pediatric”) and followed for 100 days post-HCT. Results Of 1182 HCT recipients, CDI was diagnosed in 17 % (33/192) of pediatric recipients for an incidence of 20 per 10,000 patient-days, and 11 % (107/990) of adult recipients for an incidence of 12 per 10,000. Pediatric recipients were diagnosed a median of 51 days (interquartile range [IQR]: 5, 72) after HCT and adults at 16 days (IQR = 5, 49). Compared with calendar year 2008, pediatric recipients transplanted in 2012 were at increased risk for CDI (hazard ratio [HR] = 3.99, p =.02). Myeloablative conditioning increased CDI risk in adult recipients (HR = 1.81, p =.005). Conclusions Pediatric and adult allogeneic recipients are at high risk of CDI post-HCT, particularly adult recipients of myeloablative conditioning. Differences in CDI incidence between children and adults may have resulted from exposure differences related to age; therefore, separately evaluating these groups should be considered in future CDI studies.
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Affiliation(s)
- Nicole M Boyle
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Amalia Magaret
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA ; Department of Biostatistics, University of Washington, Seattle, WA USA ; Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Zach Stednick
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Alex Morrison
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Susan Butler-Wu
- Department of Laboratory Medicine, University of Washington, Seattle, WA USA
| | - Danielle Zerr
- Seattle Children's Hospital, Seattle, WA USA ; Department of Pediatrics, University of Washington, Seattle, WA USA
| | | | | | - Anqi Cheng
- Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Anna Wald
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA ; Department of Laboratory Medicine, University of Washington, Seattle, WA USA ; Department of Medicine, University of Washington, Seattle, WA USA ; Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA ; Department of Medicine, University of Washington, Seattle, WA USA ; Infection Prevention, Seattle, WA USA
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Jamal W, Pauline E, Rotimi V. A prospective study of community-associated Clostridium difficile infection in Kuwait: Epidemiology and ribotypes. Anaerobe 2015; 35:28-32. [DOI: 10.1016/j.anaerobe.2015.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 12/16/2022]
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114
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Ferreyra JA, Wu KJ, Hryckowian AJ, Bouley DM, Weimer BC, Sonnenburg JL. Gut microbiota-produced succinate promotes C. difficile infection after antibiotic treatment or motility disturbance. Cell Host Microbe 2015; 16:770-7. [PMID: 25498344 DOI: 10.1016/j.chom.2014.11.003] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 08/15/2014] [Accepted: 10/28/2014] [Indexed: 12/29/2022]
Abstract
Clostridium difficile is a leading cause of antibiotic-associated diarrhea. The mechanisms underlying C. difficile expansion after microbiota disturbance are just emerging. We assessed the gene expression profile of C. difficile within the intestine of gnotobiotic mice to identify genes regulated in response to either dietary or microbiota compositional changes. In the presence of the gut symbiont Bacteroides thetaiotaomicron, C. difficile induces a pathway that metabolizes the microbiota fermentation end-product succinate to butyrate. The low concentration of succinate present in the microbiota of conventional mice is transiently elevated upon antibiotic treatment or chemically induced intestinal motility disturbance, and C. difficile exploits this succinate spike to expand in the perturbed intestine. A C. difficile mutant compromised in succinate utilization is at a competitive disadvantage during these perturbations. Understanding the metabolic mechanisms involved in microbiota-C. difficile interactions may help to identify approaches for the treatment and prevention of C. difficile-associated diseases.
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Affiliation(s)
- Jessica A Ferreyra
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Katherine J Wu
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Andrew J Hryckowian
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Donna M Bouley
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bart C Weimer
- Department of Population Health and Reproduction, University of California, Davis, Davis, CA 95616, USA
| | - Justin L Sonnenburg
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Flooding and Clostridium difficile Infection: A Case-Crossover Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6948-64. [PMID: 26090609 PMCID: PMC4483742 DOI: 10.3390/ijerph120606948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 01/03/2023]
Abstract
Clostridium difficile is a bacterium that can spread by water. It often causes acute gastrointestinal illness in older adults who are hospitalized and/or receiving antibiotics; however, community-associated infections affecting otherwise healthy individuals have become more commonly reported. A case-crossover study was used to assess emergency room (ER) and outpatient visits for C. difficile infection following flood events in Massachusetts from 2003 through 2007. Exposure status was based on whether or not a flood occurred prior to the case/control date during the following risk periods: 0-6 days, 7-13 days, 14-20 days, and 21-27 days. Fixed-effects logistic regression was used to estimate the risk of diagnosis with C. difficile infection following a flood. There were 129 flood events and 1575 diagnoses of C. difficile infection. Among working age adults (19-64 years), ER and outpatient visits for C. difficile infection were elevated during the 7-13 days following a flood (Odds Ratio, OR = 1.69; 95% Confidence Interval, CI: 0.84, 3.37). This association was more substantial among males (OR = 3.21; 95% CI: 1.01-10.19). Associations during other risk periods were not observed (p < 0.05). Although we were unable to differentiate community-associated versus nosocomial infections, a potential increase in C. difficile infections should be considered as more flooding is projected due to climate change.
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Ogielska M, Lanotte P, Le Brun C, Valentin AS, Garot D, Tellier AC, Halimi JM, Colombat P, Guilleminault L, Lioger B, Vegas H, De Toffol B, Constans T, Bernard L. Emergence of community-acquired Clostridium difficile infection: the experience of a French hospital and review of the literature. Int J Infect Dis 2015; 37:36-41. [PMID: 26092300 DOI: 10.1016/j.ijid.2015.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI). METHODS The cases of 136 adult patients with CDI treated at the University Hospital of Tours, France between 2008 and 2012 are described. This was a retrospective study. RESULTS Among the 136 patients included, 62 were men and 74 were women. Their median age was 64.4 years (range 18-97 years). Twenty-six of the 136 (19%) cases were community-acquired (CA) and 110 (81%) were healthcare-acquired (HCA). The major risk factors for both groups were long-term treatment with proton pump inhibitors (54% of CA, 53% of HCA patients) and antibiotic treatment within the 2.5 months preceding the CDI (50% of CA, 91% of HCA). The CSI was higher in the CA-CDI group (1.56) than in the HCA-CDI group (1.39). Intensive care was required for 8% of CA-CDI and 16.5% of HCA-CDI patients. CONCLUSIONS CDI can cause community-acquired diarrhoea, and CA-CDI may be more severe than HCA-CDI. Prospective studies of CDI involving people from the general community without risk factors are required to confirm this observation.
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Affiliation(s)
- Maja Ogielska
- Infectious Diseases Department, University Hospital of Tours, 2 boulevard Tonnellé, 37000 Tours, France.
| | | | | | - Anne Sophie Valentin
- Bacteriology and Virology Department of Bretonneau, University Hospital of Tours, France(c)Bacteriology Department of Trousseau, University Hospital of Tours, Tours, France
| | - Denis Garot
- Medical Intensive Care Unit, University Hospital of Tours, Tours, France
| | | | - Jean Michel Halimi
- Kidney Transplant Department, University Hospital of Tours, Tours, France
| | | | | | - Bertrand Lioger
- Internal Medicine Department, University Hospital of Tours, Tours, France
| | - Hélène Vegas
- Oncology Department, University Hospital of Tours, Tours, France
| | | | - Thierry Constans
- Geriatric Medicine Department, University Hospital of Tours, Tours, France
| | - Louis Bernard
- Infectious Diseases Department, University Hospital of Tours, 2 boulevard Tonnellé, 37000 Tours, France
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117
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Santiago B, Guerra L, García-Morín M, González E, Gonzálvez A, Izquierdo G, Martos A, Santos M, Navarro M, Hernández-Sampelayo M, Saavedra-Lozano J. Aislamiento de Clostridium difficile en niños hospitalizados con diarrea. An Pediatr (Barc) 2015; 82:417-25. [DOI: 10.1016/j.anpedi.2014.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/02/2014] [Accepted: 07/15/2014] [Indexed: 12/13/2022] Open
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118
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Wozniak TM, Rubin G, Raina MacIntyre C. The emergence of community-acquired Clostridium difficile in an Australian hospital. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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119
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Santiago B, Guerra L, García-Morín M, González E, Gonzálvez A, Izquierdo G, Martos A, Santos M, Navarro M, Hernández-Sampelayo M, Saavedra-Lozano J. Clostridium difficile isolation in children hospitalized with diarrhoea. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Clostridium difficile (CD), as one of the normal flora in human and animal intestine, is a Gram-positive anaerobic bacillus. It could cause opportunistic infections, resulting in CD-associated diarrhea, CD-associated colitis and other intestinal diseases. There have ever been massive epidemics of CD infection in both China and other countries, and it has became a global public health problem. The main pathogenic toxins of CD are toxin A, toxin B and newly discovered binary toxins (CDT). For CD infection prevention and treatment, the reasonable use of new antimicrobial drugs, traditional Chinese medicine, probiotics, CD vaccine and other clinical treatments can be adopted.
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Eyre DW, Tracey L, Elliott B, Slimings C, Huntington PG, Stuart RL, Korman TM, Kotsiou G, McCann R, Griffiths D, Fawley WN, Armstrong P, Dingle KE, Walker AS, Peto TE, Crook DW, Wilcox MH, Riley TV. Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012. ACTA ACUST UNITED AC 2015; 20:21059. [PMID: 25788254 DOI: 10.2807/1560-7917.es2015.20.10.21059] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than 65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for example affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.
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Affiliation(s)
- D W Eyre
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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123
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Gerding DN, Lessa FC. The epidemiology of Clostridium difficile infection inside and outside health care institutions. Infect Dis Clin North Am 2015; 29:37-50. [PMID: 25582647 PMCID: PMC10924674 DOI: 10.1016/j.idc.2014.11.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article describes the global changes in Clostridium difficile epidemiology since the late twentieth century and into the twenty-first century when the new epidemic strain BI/NAP1/027 emerged. The article provides an overview of how understanding of C difficile epidemiology has rapidly evolved since its initial association with colitis in 1974. It also discusses how C difficile has spread across the globe, the role of asymptomatic carriers in disease transmission, the increased recognition of C difficile outside health care settings, the changes in epidemiology of C difficile infection in children, and the risk factors for disease.
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Affiliation(s)
- Dale N Gerding
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, 2160 S 1st Avenue, Maywood, IL 60153, USA; Research Service, Edward Hines, Jr. Veterans Affairs Hospital, 5000 South Fifth Avenue, Building 1, Room 347, Hines, IL 60141, USA.
| | - Fernanda C Lessa
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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124
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Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, Farley MM, Holzbauer SM, Meek JI, Phipps EC, Wilson LE, Winston LG, Cohen JA, Limbago BM, Fridkin SK, Gerding DN, McDonald LC. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372:825-34. [PMID: 25714160 PMCID: PMC10966662 DOI: 10.1056/nejmoa1408913] [Citation(s) in RCA: 1870] [Impact Index Per Article: 207.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The magnitude and scope of Clostridium difficile infection in the United States continue to evolve. METHODS In 2011, we performed active population- and laboratory-based surveillance across 10 geographic areas in the United States to identify cases of C. difficile infection (stool specimens positive for C. difficile on either toxin or molecular assay in residents ≥ 1 year of age). Cases were classified as community-associated or health care-associated. In a sample of cases of C. difficile infection, specimens were cultured and isolates underwent molecular typing. We used regression models to calculate estimates of national incidence and total number of infections, first recurrences, and deaths within 30 days after the diagnosis of C. difficile infection. RESULTS A total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8% were health care-associated, but only 24.2% had onset during hospitalization. After adjustment for predictors of disease incidence, the estimated number of incident C. difficile infections in the United States was 453,000 (95% confidence interval [CI], 397,100 to 508,500). The incidence was estimated to be higher among females (rate ratio, 1.26; 95% CI, 1.25 to 1.27), whites (rate ratio, 1.72; 95% CI, 1.56 to 2.0), and persons 65 years of age or older (rate ratio, 8.65; 95% CI, 8.16 to 9.31). The estimated number of first recurrences of C. difficile infection was 83,000 (95% CI, 57,000 to 108,900), and the estimated number of deaths was 29,300 (95% CI, 16,500 to 42,100). The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among health care-associated infections than among community-associated infections (30.7% vs. 18.8%, P<0.001). CONCLUSIONS C. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011. (Funded by the Centers for Disease Control and Prevention.).
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Furuya-Kanamori L, Stone JC, Clark J, McKenzie SJ, Yakob L, Paterson DL, Riley TV, Doi SAR, Clements AC. Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2015; 36:132-41. [PMID: 25632995 DOI: 10.1017/ice.2014.39] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. METHODS A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted. RESULTS Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18; 95% CI, 3.80-10.04) and corticosteroid (1.81; 1.15-2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72; 95% CI, 1.52-9.12), renal failure (2.64; 1.23-5.68), hematologic cancer (1.75; 1.02-5.68), and diabetes mellitus (1.15; 1.05-1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years. CONCLUSIONS Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening.
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Affiliation(s)
- Luis Furuya-Kanamori
- 1Research School of Population Health,Australian National University,Canberra,Australia
| | - Jennifer C Stone
- 2School of Population Health,University of Queensland,Herston,Australia
| | | | | | - Laith Yakob
- 4Department of Disease Control,London School of Hygiene & Tropical Medicine,London,UK
| | - David L Paterson
- 5University of Queensland,UQ Centre for Clinical Research,Herston,Australia
| | - Thomas V Riley
- 6Microbiology & Immunology,University of Western Australia, andDepartment of Microbiology PathWest Laboratory Medicine,Queen Elizabeth II Medical Centre,Nedlands,Australia
| | - Suhail A R Doi
- 2School of Population Health,University of Queensland,Herston,Australia
| | - Archie C Clements
- 1Research School of Population Health,Australian National University,Canberra,Australia
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126
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Martin J. The contribution of strains and hosts to outcomes in Clostridium difficile infection. Infect Dis Clin North Am 2015; 29:51-61. [PMID: 25582645 DOI: 10.1016/j.idc.2014.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acquisition of Clostridium difficile spores can be followed by a spectrum of clinical outcomes ranging from asymptomatic transit through the bowel to severe colitis and death. This clinical variability is a product of bacterial virulence and host susceptibility to the pathogen. It is important to identify patients at high risk of poor outcome so that increased monitoring and optimal treatment strategies can be instigated. This article discusses the evidence linking strain type to clinical outcome, including the importance of toxin and nontoxin virulence factors. It reviews host factors and their relationship with C difficile infection susceptibility, recurrence, and mortality.
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Affiliation(s)
- Jessica Martin
- University of Leeds, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX, UK.
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127
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Abstract
The view of Clostridium difficile infection as a hospital-acquired infection transmitted only by symptomatic patients is changing. Although C difficile is present in food for human consumption, food-borne infection caused by C difficile has never been confirmed. More information on the infective dose and the level of contamination is needed to determine the risk for food-borne exposure to C difficile in humans. The emergence of C difficile polymerase chain reaction (PCR) ribotype 078 in humans is epidemiologically linked to its presence in piglets and calves and their environment, suggesting zoonotic transmission.
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Affiliation(s)
- Martijn P Bauer
- Department of Infectious Diseases, Center for Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Center for Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
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128
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Lopardo G, Morfin-Otero R, Moran-Vazquez II, Noriega F, Zambrano B, Luxemburger C, Foglia G, Rivas EE. Epidemiology of Clostridium difficile: a hospital-based descriptive study in Argentina and Mexico. Braz J Infect Dis 2015; 19:8-14. [PMID: 25179510 PMCID: PMC9425260 DOI: 10.1016/j.bjid.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 01/05/2023] Open
Abstract
A prospective study was conducted in four tertiary hospitals in Argentina and Mexico in order to describe the occurrence of Clostridium difficile infection (CDI) in these settings. The objective was to evaluate the incidence of CDI in at-risk populations in Argentina (one center) and Mexico (three centers) and to further explore potential study sites for vaccine development in this region. A prospective, descriptive, CDI surveillance study was conducted among hospitalized patients aged ≥40 years who had received ≥48 h of antibiotic treatment. Stool samples were collected from those with diarrhea within 30 days after starting antibiotics and analyzed for toxins A and B by ELISA, and positive samples were further tested by toxinogenic culture and restriction endonuclease analysis type assay. Overall, 466 patients were enrolled (193 in Argentina and 273 in Mexico) of whom 414 completed the follow-up. Of these, 15/414 (3.6%) experienced CDI episodes occurring on average 18.1 days after admission to hospital and 15.9 days after the end of antibiotics treatment. The incidence rate of CDI was 3.1 (95% CI 1.7–5.2) per 1000 patient-days during hospitalization, and 1.1 (95% CI 0.6–1.8) per 1000 patient-days during the 30-day follow-up period. This study highlighted the need for further evaluation of the burden of CDI in both countries, including the cases occurring after discharge from hospital.
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129
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Squire MM, Knight DR, Riley TV. Community-acquired Clostridium difficile infection and Australian food animals. MICROBIOLOGY AUSTRALIA 2015. [DOI: 10.1071/ma15040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Clostridium difficile is an anaerobic Gram positive spore-forming bacterium, the leading cause of infectious diarrhoea (C. difficile infection; CDI) in hospitalised humans. The assumption that CDI is primarily a hospital-acquired infection is being questioned. Community-acquired CDI (CA-CDI) is increasing1 particularly in groups previously considered at low risk2,3. In Australia, CA-CDI rates doubled during 2011 and increased by 24% between 2011 and 20124. Two potentially high-risk practices in Australian food animal husbandry may present a risk for CA-CDI: slaughtering of neonatal animals for food, and effluent recycling to agriculture.
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130
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Kuntz JL, Polgreen PM. The Importance of Considering Different Healthcare Settings When Estimating the Burden of Clostridium difficile. Clin Infect Dis 2014; 60:831-6. [DOI: 10.1093/cid/ciu955] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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131
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Clayton J, McHale-Owen J. Outbreak of Clostridium difficile ribotype 027 in a residential home. J Hosp Infect 2014; 88:222-5. [DOI: 10.1016/j.jhin.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
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132
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Hensgens M, Dekkers O, Demeulemeester A, Buiting A, Bloembergen P, van Benthem B, Le Cessie S, Kuijper E. Diarrhoea in general practice: when should a Clostridium difficile infection be considered? Results of a nested case-control study. Clin Microbiol Infect 2014; 20:O1067-74. [DOI: 10.1111/1469-0691.12758] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/22/2014] [Accepted: 07/02/2014] [Indexed: 12/01/2022]
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133
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Smith AM, Wuerth BA, Wiemken TL, Arnold FW. Prevalence of Clostridium difficile infection presenting to US EDs. Am J Emerg Med 2014; 33:238-43. [PMID: 25488337 DOI: 10.1016/j.ajem.2014.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/07/2014] [Accepted: 11/20/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The objective of the study is to determine the prevalence of Clostridium difficile infection (CDI) presenting to emergency departments (EDs) in the United States. Secondary objectives included defining the burden of CDI. METHODS This is a retrospective, observational cohort study of 2006-2010 Nationwide Emergency Department Sample database of 980 US hospital EDs in 29 states. Prevalence, mortality rate, length of stay, hospital charges, and endemicity were measured. RESULTS A total of 474513 patients with CDI-related ED visits were identified. From 2006 to 2010, the prevalence of CDI increased from 26.2 to 33.1 per 100,000 population (P<.001). The number of CDI-related ED cases increased 26.1% (P<.001) over the study period: 18.6% from 2006 to 2007 (P<.001), 4.3% from 2007 to 2008 (P=.46), 1.8% from 2008 to 2009 (P=.73), and 0.13% from 2009 to 2010 (P=.95). Emergency department visits occurred more frequently with individuals 85 years or older (relative risk [RR], 13.74; P<.001), females (RR, 1.77; P<.001) and in the northeast United States (RR, 1.42; P<.001). From 2009 to 2010, the mortality rate decreased 17.9% (P=.01). CONCLUSIONS The prevalence of CDI presenting to EDs increased each year from 2006 to 2010; however, the rate of increase slowed from each year to the next. The mortality rate increased from 2006 to 2009 and decreased significantly from 2009 to 2010. C difficile infection visits presenting to EDs occurred more frequently with older individuals, females, and in the northeast.
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Affiliation(s)
- Aaron M Smith
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Brandon A Wuerth
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Timothy L Wiemken
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, USA.
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Knetsch CW, Connor TR, Mutreja A, van Dorp SM, Sanders IM, Browne HP, Harris D, Lipman L, Keessen EC, Corver J, Kuijper EJ, Lawley TD. Whole genome sequencing reveals potential spread of Clostridium difficile between humans and farm animals in the Netherlands, 2002 to 2011. ACTA ACUST UNITED AC 2014; 19:20954. [PMID: 25411691 DOI: 10.2807/1560-7917.es2014.19.45.20954] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Farm animals are a potential reservoir for human Clostridium difficile infection (CDI), particularly PCR ribotype 078 which is frequently found in animals and humans. Here, whole genome single-nucleotide polymorphism (SNP) analysis was used to study the evolutionary relatedness of C. difficile 078 isolated from humans and animals on Dutch pig farms. All sequenced genomes were surveyed for potential antimicrobial resistance determinants and linked to an antimicrobial resistance phenotype. We sequenced the whole genome of 65 C. difficile 078 isolates collected between 2002 and 2011 from pigs (n = 19), asymptomatic farmers (n = 15) and hospitalised patients (n = 31) in the Netherlands. The collection included 12 pairs of human and pig isolates from 2011 collected at 12 different pig farms. A mutation rate of 1.1 SNPs per genome per year was determined for C. difficile 078. Importantly, we demonstrate that farmers and pigs were colonised with identical (no SNP differences) and nearly identical (less than two SNP differences) C. difficile clones. Identical tetracycline and streptomycin resistance determinants were present in human and animal C. difficile 078 isolates. Our observation that farmers and pigs share identical C. difficile strains suggests transmission between these populations, although we cannot exclude the possibility of transmission from a common environmental source.
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Affiliation(s)
- C W Knetsch
- Section Experimental Bacteriology, Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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Eckert C, Emirian A, Le Monnier A, Cathala L, De Montclos H, Goret J, Berger P, Petit A, De Chevigny A, Jean-Pierre H, Nebbad B, Camiade S, Meckenstock R, Lalande V, Marchandin H, Barbut F. Prevalence and pathogenicity of binary toxin-positive Clostridium difficile strains that do not produce toxins A and B. New Microbes New Infect 2014; 3:12-7. [PMID: 25755885 PMCID: PMC4337936 DOI: 10.1016/j.nmni.2014.10.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/15/2014] [Accepted: 10/07/2014] [Indexed: 12/17/2022] Open
Abstract
Clostridium difficile causes antibiotic-associated diarrhoea and pseudomembranous colitis. The main virulence factors of C. difficile are the toxins A (TcdA) and B (TcdB). A third toxin, called binary toxin (CDT), can be detected in 17% to 23% of strains, but its role in human disease has not been clearly defined. We report six independent cases of patients with diarrhoea suspected of having C. difficile infection due to strains from toxinotype XI/PCR ribotype 033 or 033-like, an unusual toxinotype/PCR ribotype positive for CDT but negative for TcdA and TcdB. Four patients were considered truly infected by clinicians and were specifically treated with oral metronidazole. One of the cases was identified during a prevalence study of A(-)B(-)CDT(+) strains. In this study, we screened a French collection of 220 nontoxigenic strains and found only one (0.5%) toxinotype XI/PCR ribotype 033 or 033-like strain. The description of such strains raises the question of the role of binary toxin as a virulence factor and could have implications for laboratory diagnostics that currently rarely include testing for binary toxin.
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Affiliation(s)
- C Eckert
- Laboratoire associé « Clostridium difficile », Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, France ; UPMC Univ Paris VI, GRC n°2, Epidiff, France
| | - A Emirian
- Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - A Le Monnier
- Laboratoire de Bactériologie, Groupe Hospitalier Paris Saint Joseph, Paris, France ; EA 4043, Université Paris-Sud 11, Faculté de Pharmacie, Châtenay-Malabry, France
| | - L Cathala
- Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, France
| | - H De Montclos
- Laboratoire de Bactériologie, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - J Goret
- Laboratoire de Bactériologie, CHU de Bordeaux, Bordeaux, France
| | - P Berger
- Institut Paoli-Calmettes, Marseille, France
| | - A Petit
- Laboratoire associé « Clostridium difficile », Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - A De Chevigny
- Laboratoire associé « Clostridium difficile », Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, France
| | - H Jean-Pierre
- Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, France ; UMR5119 ECOSYM, Equipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France
| | - B Nebbad
- Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - S Camiade
- Laboratoire Alphabio, Marseille, France
| | - R Meckenstock
- Service de Médecine Interne Maladies Infectieuses, Hôpital André Mignot, Le Chesnay, France
| | - V Lalande
- Laboratoire associé « Clostridium difficile », Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, France ; Laboratoire de Microbiologie, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - H Marchandin
- Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, France ; UMR5119 ECOSYM, Equipe Pathogènes et Environnements, Université Montpellier 1, Montpellier, France
| | - F Barbut
- Laboratoire associé « Clostridium difficile », Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, France ; UPMC Univ Paris VI, GRC n°2, Epidiff, France ; Laboratoire de Microbiologie, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
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136
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Reigadas E, Alcalá L, Marín M, Burillo A, Muñoz P, Bouza E. Missed diagnosis of Clostridium difficile infection; a prospective evaluation of unselected stool samples. J Infect 2014; 70:264-72. [PMID: 25452039 DOI: 10.1016/j.jinf.2014.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/25/2014] [Accepted: 10/19/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhoea in developed countries, however a high proportion of CDI episodes go undiagnosed, either because physicians do not request identification of toxigenic C. difficile or microbiologists do not perform the appropriate tests. OBJECTIVE To investigate the clinical characteristics of patients with CDI within a non-selected population and to determine risk factors for clinical underdiagnosis. METHODS We conducted a prospective study in which systematic testing for toxigenic C. difficile on all diarrhoeic stool samples was performed regardless of the clinician's request. Patients aged >2 years positive for toxigenic C. difficile and diarrhoea were enrolled (Jan-June 2013) and monitored at least 2 months after their last episode. RESULTS We identified 204 cases of CDI, of which three-quarters were healthcare-associated. Most cases were mild to moderate (83.8%), the recurrence rate was 16.2%, and CDI-related mortality was low (2.5%). A significant proportion (12.7%) of CDI cases would have been missed owing to lack of clinical suspicion. Community-acquired cases and young age were risk factors for clinical underdiagnosis. CONCLUSION Our data support the introduction of a systematic search for toxigenic C. difficile in all diarrhoeic stools from inpatients and outpatients older than 2 years.
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Affiliation(s)
- E Reigadas
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - L Alcalá
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - M Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - A Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
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Abstract
BACKGROUND The criteria used when GPs submit stool specimens for microbiological investigation are unknown. AIM To determine what criteria GPs use to send stool specimens, and if they are consistent with national guidance, and whether GPs would prescribe an antibiotic before they receive a result. DESIGN AND SETTING Questionnaire survey of 974 GPs in 172 surgeries in England. METHOD GPs were sent a questionnaire (23 questions) based on national guidance. RESULTS Questionnaires were returned by 90% (154/172) of surgeries and 49% (477/968) of GPs. GPs reported sending stool specimens in about 50% of cases of suspected infectious diarrhoea, most commonly because of individual symptoms, rather than public health implications. Fewer considered sampling with antibiotic-associated diarrhoea post hospitalisation, or children with acute, painful, bloody diarrhoea; only 14% mentioned outbreaks as a reason. Nearly one-half of GPs reported they would consider antibiotics in suspected cases of Escherichia coli O157, which is contraindicated. Only 23% of GPs would send the recommended three specimens for ova, cysts, and parasites (OCP) examination. Although 89% of GPs gave some verbal advice on how to collect stool specimens, only 2% of GPs gave patients any written instructions. CONCLUSION GPs need more education to address gaps in knowledge about the risks and diagnosis of different infections in suspected infectious diarrhoea, especially Clostridium difficile post-antibiotics, E. coli O157, and requesting OCPs. Advice on reports, tick boxes, or links to guidance on electronic request forms may facilitate this.
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138
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Gupta SB, Dubberke ER. Overview and changing epidemiology of Clostridium difficile infection. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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139
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Efficacy and safety of, and patient satisfaction with, colonoscopic-administered fecal microbiota transplantation in relapsing and refractory community- and hospital-acquired Clostridium difficile infection. Can J Gastroenterol Hepatol 2014; 28:434-8. [PMID: 25014180 PMCID: PMC4210234 DOI: 10.1155/2014/695029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To report the efficacy and safety of, and patient satisfaction with, colonoscopic fecal microbiota transplantation (FMT) for community- and hospital-acquired Clostridium difficile infection (CDI). METHODS A retrospective medical records review of patients who underwent FMT between July 1, 2012 and August 31, 2013 was conducted. A total of 22 FMTs were performed on 20 patients via colonoscopy. The patients were divided into 'community-acquired' and 'hospital-acquired' CDI. Telephone surveys were conducted to determine procedure outcome and patient satisfaction. Primary cure rate was defined as resolution of diarrhea without recurrence within three months of FMT, whereas secondary cure rate described patients who experienced resolution of diarrhea and return of normal bowel function after a second course of FMT. RESULTS Nine patients met the criteria for community-acquired CDI whereas 11 were categorized as hospital-acquired CDI. A female predominance in the community-acquired group (88.89% [eight of nine]) was found (P=0.048). The primary cure rate was 100% (nine of nine) and 81.8% (nine of 11 patients) in community- and hospital-acquired CDI groups, respectively (P=0.189). Two patients in the hospital-acquired group had to undergo a repeat FMT for persistent symptomatic infection; the secondary cure rate was 100%. During the six-month follow-up, all patients were extremely satisfied with the procedure and no complications or adverse events were reported. CONCLUSION FMT was a highly successful and very acceptable treatment modality for treating both community- and hospital-acquired CDI.
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140
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Molina Rueda MJ, Onieva García MA, Jiménez Romano E, Fernández Sierra MA. [Outbreak of Clostridium difficile infection in a hematopoietic stem cell transplantation unit]. Med Clin (Barc) 2014; 143:188-9. [PMID: 24361148 DOI: 10.1016/j.medcli.2013.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
Affiliation(s)
- María José Molina Rueda
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Granada, España.
| | | | - Elena Jiménez Romano
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Granada, España
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141
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Le Monnier A, Zahar JR, Barbut F. Update on Clostridium difficile infections. Med Mal Infect 2014; 44:354-65. [DOI: 10.1016/j.medmal.2014.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/01/2014] [Indexed: 12/18/2022]
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142
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Novak A, Spigaglia P, Barbanti F, Goic-Barisic I, Tonkic M. First clinical and microbiological characterization of Clostridium difficile infection in a Croatian University Hospital. Anaerobe 2014; 30:18-23. [PMID: 25079669 DOI: 10.1016/j.anaerobe.2014.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 01/16/2023]
Abstract
Clinical background and molecular epidemiology of Clostridium difficile infection (CDI) in the University Hospital Centre Split were investigated from January 2010 to December 2011. In total, 54 patients with first episode of CDI were consecutively included in the study based on the positive EIA test specific for A and B toxins. Demographic and clinical data were prospectively analyzed from medical records. CDI incidence rate was 0.6 per 10,000 patient-days. Thirty six cases (70.6%) were healthcare-associated, twelve cases (23.5%) were community-associated and three (5.9%) were indeterminate. Six patients (11.7%) had suffered one or more recurrences and 37 patients (72.5%) showed severe CDI. Prior therapy with third generation cephalosporin was significantly associated with severe CDI (P<0.021). Fifty four toxigenic C. difficile strains were isolated and 50 of them were available for PCR-ribotyping. Sixteen different PCR-ribotypes were identified. The most prevalent were PCR-ribotype 001 (27.8%) and 014/020 (24.1%). Twenty three strains were resistant to at least one of the antibiotics tested. Among resistant strains, three (13.0%)--all PCR-ribotype 001--were multi-resistant. Resistance to fluoroquinolones was significantly higher in strains that caused infection after previous use of fluoroquinolones (P=0.04).
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Affiliation(s)
- Anita Novak
- University Hospital Centre Split, Croatia; University of Split School of Medicine, Split, Croatia.
| | - Patrizia Spigaglia
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fabrizio Barbanti
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ivana Goic-Barisic
- University Hospital Centre Split, Croatia; University of Split School of Medicine, Split, Croatia
| | - Marija Tonkic
- University Hospital Centre Split, Croatia; University of Split School of Medicine, Split, Croatia
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Lessa FC, Mu Y, Winston LG, Dumyati GK, Farley MM, Beldavs ZG, Kast K, Holzbauer SM, Meek JI, Cohen J, McDonald LC, Fridkin SK. Determinants of Clostridium difficile Infection Incidence Across Diverse United States Geographic Locations. Open Forum Infect Dis 2014; 1:ofu048. [PMID: 25734120 PMCID: PMC4281776 DOI: 10.1093/ofid/ofu048] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/05/2014] [Indexed: 12/12/2022] Open
Abstract
Nucleic acid amplification test, age, race and sex are associated with increased community-associated Clostridium difficile infection (CDI) incidence, while age and number of inpatient-days are associated with increased healthcare-associated CDI incidence. Comparison of CDI incidence across regions should account for these factors. Background Clostridium difficile infection (CDI) is no longer restricted to hospital settings, and population-based incidence measures are needed. Understanding the determinants of CDI incidence will allow for more meaningful comparisons of rates and accurate national estimates. Methods Data from active population- and laboratory-based CDI surveillance in 7 US states were used to identify CDI cases (ie, residents with positive C difficile stool specimen without a positive test in the prior 8 weeks). Cases were classified as community-associated (CA) if stool was collected as outpatients or ≤3 days of admission and no overnight healthcare facility stay in the past 12 weeks; otherwise, cases were classified as healthcare-associated (HA). Two regression models, one for CA-CDI and another for HA-CDI, were built to evaluate predictors of high CDI incidence. Site-specific incidence was adjusted based on the regression models. Results Of 10 062 cases identified, 32% were CA. Crude incidence varied by geographic area; CA-CDI ranged from 28.2 to 79.1/100 000 and HA-CDI ranged from 45.7 to 155.9/100 000. Independent predictors of higher CA-CDI incidence were older age, white race, female gender, and nucleic acid amplification test (NAAT) use. For HA-CDI, older age and a greater number of inpatient-days were predictors. After adjusting for relevant predictors, the range of incidence narrowed greatly; CA-CDI rates ranged from 30.7 to 41.3/100 000 and HA-CDI rates ranged from 58.5 to 94.8/100 000. Conclusions Differences in CDI incidence across geographic areas can be partially explained by differences in NAAT use, age, race, sex, and inpatient-days. Variation in antimicrobial use may contribute to the remaining differences in incidence.
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Affiliation(s)
- Fernanda C Lessa
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Yi Mu
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Lisa G Winston
- Division of Infectious Diseases , University of California, San Francisco School of Medicine
| | - Ghinwa K Dumyati
- Division of Infectious Diseases , University of Rochester Medical Center , New York
| | - Monica M Farley
- Division of Infectious Diseases , Emory University School of Medicine , Atlanta, Georgia ; Atlanta Veterans Affairs Medical Center , Georgia
| | | | - Kelly Kast
- Colorado Department of Public Health and Environment, Denver
| | - Stacy M Holzbauer
- Centers for Disease Control and Prevention Epidemiology Field Officer Assigned to Minnesota Department of Health, St. Paul, Minnesota
| | - James I Meek
- Emerging Infections Program , Yale University School of Public Health , New Haven, Connecticut
| | - Jessica Cohen
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia ; Atlanta Research and Education Foundation , Georgia
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Scott K Fridkin
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
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Eckert C, Jones G, Barbut F. Diagnosis of Clostridium difficile infection: the molecular approach. Future Microbiol 2014; 8:1587-98. [PMID: 24266358 DOI: 10.2217/fmb.13.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Diagnosis of Clostridium difficile infection is based on clinical presentation and laboratory tests. Although numerous laboratory methods are now available, the diagnosis of C. difficile infection remains challenging. Nucleic acid amplification tests (NAATs) are the most recent marketed methods. These methods detect genes for toxins A and/or B. They are very sensitive compared with the reference method (toxigenic culture) and are thus very promising, despite their cost. However, a positive NAAT result must be interpreted with caution owing to the possible detection of asymptomatic carriers of toxigenic strains who may have diarrhea for other reasons. The place of NAATs in current diagnostic strategies needs to be better defined, but the rapidity of the result is interesting for early recognition of the disease.
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Affiliation(s)
- Catherine Eckert
- National Reference Laboratory for Clostridium difficile, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
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145
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Colenutt C, Cutting SM. Use of Bacillus subtilis PXN21 spores for suppression of Clostridium difficile infection symptoms in a murine model. FEMS Microbiol Lett 2014; 358:154-61. [PMID: 24828432 DOI: 10.1111/1574-6968.12468] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/02/2014] [Accepted: 05/12/2014] [Indexed: 12/18/2022] Open
Abstract
Clostridium difficile is the primary cause of nosocomial diarrhoea in healthcare centres of the developed world. Only a few antibiotics are available for treatment, and relapses are common in patients undergoing antibiotic therapy. New approaches are required to reduce reliance on antibiotics, the use of which represents a primary risk factor for development of C. difficile infections. Supplementation of the gut flora with probiotics represents a key area for producing more successful treatment options for C. difficile infection (CDI). In this study, spores of B. subtilis have been evaluated as a potential probiotic treatment against CDI. Using a murine model of infection, we demonstrate that oral administration of B. subtilis spores can attenuate the symptoms of infection. We further show that (1) suppression of symptoms was better if spores were administered post infection, and (2) germination of the spore to a vegetative cell may be an integral part of how CDI is suppressed. The results of this study highlight the potential of this bacterium as a probiotic treatment for CDI.
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Affiliation(s)
- Claire Colenutt
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey, UK
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146
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Characteristics of Clostridium difficile colonization in Japanese children. J Infect Chemother 2014; 20:307-11. [DOI: 10.1016/j.jiac.2014.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 02/04/2023]
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147
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Abstract
There has been dramatic change in the epidemiology of Clostridium difficile infection (CDI) since the turn of the 21st century noted by a marked increase in incidence and severity, occurring at a disproportionately higher frequency in older patients. Historically considered a nosocomial infection associated with antibiotic exposure, CDI has now also emerged in the community in populations previously considered low risk. Emerging risk factors and disease recurrence represent continued challenges in the management of CDI. The increased incidence and severity associated with CDI has coincided with the emergence and rapid spread of a previously rare strain, ribotype 027. Recent data from the United States and Europe suggest that the incidence of CDI may have reached a crescendo in the recent years and is perhaps beginning to plateau. The acute care direct costs of CDI were estimated to be US$4.8 billion in 2008. However, nearly all the published studies have focused on CDI diagnosed and treated in the acute care hospital setting and fail to measure the burden outside the hospital, including recently discharged patients, outpatients, and those in long-term care facilities. Enhanced surveillance methods are needed to monitor the incidence, to identify populations at risk, and to characterize the molecular epidemiology of strains causing CDI.
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148
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Taori SK, Wroe A, Hardie A, Gibb AP, Poxton IR. A prospective study of community-associated Clostridium difficile infections: the role of antibiotics and co-infections. J Infect 2014; 69:134-44. [PMID: 24780765 DOI: 10.1016/j.jinf.2014.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/12/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This prospective study was performed to determine the incidence, risk factors, severity and outcomes of community-associated Clostridium difficile infection (CA-CDI) in the SE of Scotland. METHODS All patients (335) diagnosed with laboratory confirmed CDI in the city of Edinburgh, East Lothian and Midlothian regions of Scotland between August 2010 and July 2011 were followed up for one year after diagnosis. Clinical details and laboratory markers were recorded. Stool samples were tested for C. difficile, other bacterial pathogens and norovirus. Molecular epidemiology of C. difficile isolates was studied by PCR-ribotyping. RESULTS Of the total 335 confirmed CDI cases, PCR-ribotype 001 was the commonest (14.1%), followed by PCR-ribotypes 078 (12.9%) and 015 (11.7%), respectively. CA-CDI represented 12.5% of the cases. In these, PCR-ribotype 078 was the commonest (19.0%), followed by PCR-ribotypes 014/020 (16.7%), PCR-ribotype 015 (14.3% and PCR-ribotype 001 (11.9%). A lower Charlson co-morbidity index and a lower age was observed in the CA-CDI group as was total number of different antibiotic classes whereas age >75 was more common in the HA-CDI group. On multivariable analysis presence of PCR-ribotype 078 was significantly associated with community acquisition (p = 0.006) whereas a greater proportion of immunosuppressed patients and those on antibiotics 8 weeks preceding diagnosis (p = 0.035 and p = 0.005 respectively) were found among HA-CDI cases. Charlson co-morbidity index, number of different antibiotics given in the eight weeks preceding onset, severity of infection and rural residence were not significantly different between the two groups. CONCLUSION This study demonstrates that patients with CA-CDI may also present with severe infection, are less likely to receive antibiotics prior to CDI, more likely to be younger in age and have a greater proportion of PCR-ribotype 078 compared with CDI acquired in a hospital setting. Hence a high level of vigilance must be maintained to detect CDI cases which present in the community without the traditional predisposing factors.
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Affiliation(s)
- Surabhi K Taori
- Microbial Pathogenicity Research Laboratory, Medical Microbiology, The Chancellors Building, University of Edinburgh, 49, Little France Crescent, Edinburgh EH16 4SB, UK.
| | - Allison Wroe
- Microbial Pathogenicity Research Laboratory, Medical Microbiology, The Chancellors Building, University of Edinburgh, 49, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Alison Hardie
- Specialist Virology Centre, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh EH16 4SA, UK
| | - Alan P Gibb
- Department of Clinical Microbiology, Royal Infirmary of Edinburgh, 51, Little France Crescent, Edinburgh EH16 4SA, UK
| | - Ian R Poxton
- Microbial Pathogenicity Research Laboratory, Medical Microbiology, The Chancellors Building, University of Edinburgh, 49, Little France Crescent, Edinburgh EH16 4SB, UK
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Barbut F, Guery B, Eckert C. Comment traiter une infection digestive à Clostridium difficile en 2014 ? ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0867-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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150
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Simango C, Uladi S. Detection of Clostridium difficile diarrhoea in Harare, Zimbabwe. Trans R Soc Trop Med Hyg 2014; 108:354-7. [PMID: 24664819 DOI: 10.1093/trstmh/tru042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Clostridium difficile is associated with nosocomial and community-acquired diarrhoea and pseudomembranous colitis in humans. Little information is available on the importance of C. difficile as a causative agent of diarrhoea in developing countries such as Zimbabwe. The current study was carried out to determine the prevalence of C. difficile in diarrhoeal stools of outpatients over 2 years of age presenting at healthcare centres in Harare, Zimbabwe, and to determine the antimicrobial susceptibility of the isolates. METHODS Toxigenic stool culture was used in this study. Diarrhoeal stool specimens were cultured for C. difficile, followed by direct immunoassay on colonies of positive cultures with significant growth to detect toxins A or B. RESULTS C. difficile was detected in 8.6% (n=23) of the 268 diarrhoeal stool specimens. All C. difficile isolates were susceptible to metronidazole, vancomycin, chloramphenicol and doxycyline, and resistant to clindamycin, ciprofloxacin, gentamicin and cefotaxime. About 70% of the isolates were resistant to co-trimoxazole. CONCLUSIONS C. difficile was observed to be an important diarrhoeal pathogen and metronidazole was effective in treating diarrhoea caused by the bacterium. Co-trimoxazole, which is widely used as prophylaxis against opportunistic infections in HIV/AIDS patients, was not very effective in preventing diarrhoea caused by C. difficile.
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Affiliation(s)
- Clifford Simango
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Harare, Zimbabwe
| | - Steven Uladi
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Harare, Zimbabwe
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