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Ayada G, Atamna A, Babich T, Ben Zvi H, Elis A, Bishara J. Community versus health care-associated Clostridioides difficile infection: A comparison between clinical characteristics and outcomes in hospitalized patients. Am J Infect Control 2023; 51:1339-1343. [PMID: 37290688 DOI: 10.1016/j.ajic.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) can be divided according to its acquisition site, health care (HC) or community (CA) associated CDI. Studies showed severe disease, higher recurrence, and mortality among HC-CDI patients, while others reported the opposite. We aimed to compare the outcomes according to the CDI acquisition site. METHODS The study analyzed medical records and laboratory computerized system data to identify patients (≥18 years old) who were hospitalized with the first CDI from January 2013 to March 2021. Patients were divided into HC-CDI and CA-CDI groups. The primary outcome was 30-day mortality. Other outcomes: CDI severity, colectomy, intensive care unit (ICU) admission, length of hospitalization, 30 and 90-day recurrence, and 90 days all-cause mortality. RESULTS Of 867 patients, 375 were defined as CA-CDI and 492 as HC-CDI. CA-CDI patients had more underlying malignancy (26% vs 21% P = .04) and inflammatory bowel disease (7% vs 1%, P < .001). The 30 days mortality was similar (10% CA-CDI and 12% HC-CDI, P = .5), and the acquisition site was not found to be a risk factor. There was no difference in severity nor in complications, but the recurrence rate was higher among those with CA-CDI (4% vs 2%, P = .055). CONCLUSIONS There were no differences between the CA-CDI and HC-CDI groups regarding rates, in-hospital complications, short-term mortality, and 90-day recurrence rates. However, the CA-CDI patients had a higher recurrence rate at 30 days.
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Affiliation(s)
- Gida Ayada
- Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Alaa Atamna
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | - Tanya Babich
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Haim Ben Zvi
- Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Avishay Elis
- Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Lim SC, Collins DA, Imwattana K, Knight DR, Perumalsamy S, Hain-Saunders NMR, Putsathit P, Speers D, Riley TV. Whole-genome sequencing links Clostridium (Clostridioides) difficile in a single hospital to diverse environmental sources in the community. J Appl Microbiol 2021; 133:1156-1168. [PMID: 34894035 DOI: 10.1111/jam.15408] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
AIMS To investigate if Clostridium (Clostridioides) difficile infection (CDI), traditionally thought of as hospital-acquired, can be genomically linked to hospital or community environmental sources, and to define possible importation routes from the community to the hospital. METHODS AND RESULTS In 2019, C. difficile was isolated from 89/300 (29.7%) floor and 96/300 (32.0%) shoe sole samples at a tertiary hospital in Western Australia. Non-toxigenic C. difficile ribotype (RT) 010 predominated among floor (96.6%) and shoe sole (73.2%) isolates, while toxigenic RT 014/020 was most prevalent among contemporaneous clinical cases (33.0%) at the hospital. Whole-genome sequencing and high-resolution core genome single nucleotide polymorphism (cgSNP) analysis on C. difficile strains from hospital and community sources showed no clinical C. difficile RT 014/020 strains were genetically related, and evidence of frequent long-distance, multi-directional spread between humans, animals and the environment. In addition, cgSNP analysis of environmental RT 010 strains suggested transportation of C. difficile via shoe soles. CONCLUSIONS While C. difficile RT 014/020 appears to spread via routes outside the healthcare system, RT 010 displayed a pattern of possible importation from the community into the hospital. SIGNIFICANCE AND IMPACT OF STUDY These findings suggest developing community-based infection prevention and control strategies could significantly lower rates of CDI in the hospital setting.
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Affiliation(s)
- Su-Chen Lim
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Deirdre A Collins
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Korakrit Imwattana
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Daniel R Knight
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Biosecurity and One Health Research Centre, Harry Butler Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Sicilia Perumalsamy
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Natasza M R Hain-Saunders
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Biosecurity and One Health Research Centre, Harry Butler Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Papanin Putsathit
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David Speers
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Thomas V Riley
- School of Medical & Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Biosecurity and One Health Research Centre, Harry Butler Institute, Murdoch University, Murdoch, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
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Lim SC, Hain-Saunders NMR, Imwattana K, Putsathit P, Collins DA, Riley TV. Genetically related Clostridium difficile from water sources and human CDI cases revealed by whole-genome sequencing. Environ Microbiol 2021; 24:1221-1230. [PMID: 34693624 DOI: 10.1111/1462-2920.15821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 02/04/2023]
Abstract
Clostridium difficile isolates from the environment are closely related to those from humans, indicating a possible environmental transmission route for C. difficile infection (CDI). In this study, C. difficile was isolated from 47.3% (53/112) of lake/pond, 23.0% (14/61) of river, 20.0% (3/15) of estuary and 0.0% (0/89) of seawater samples. The most common toxigenic strain isolated was C. difficile PCR ribotype (RT) 014/020 (10.5%, 8/76). All water isolates were susceptible to fidaxomicin, metronidazole, rifaximin, amoxicillin/clavulanic acid, moxifloxacin and tetracycline. Resistance to vancomycin, clindamycin, erythromycin and meropenem was detected in 5.3% (4/76), 26.3% (20/76), 1.3% (1/76) and 6.6% (5/76) of isolates, respectively. High-resolution core-genome analysis was performed on RT 014/020 isolates of water origin and 26 clinical RT 014/020 isolates from the same year and geographical location. Notably, both human and water strains were intermixed across three sequence types (STs), 2, 13 and 49. Six closely related groups with ≤10 core-genome single nucleotide polymorphisms were identified, five of which comprised human and water strains. Overall, 19.2% (5/26) of human strains shared a recent genomic relationship with one or more water strains. This study supports the growing hypothesis that environmental contamination by C. difficile plays a role in CDI transmission.
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Affiliation(s)
- Su-Chen Lim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Natasza M R Hain-Saunders
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical, Molecular and Forensic Sciences, Murdoch University, Perth, WA, Australia
| | - Korakrit Imwattana
- School of Biomedical Sciences, The University of Western Australia, Nedlands, WA, Australia
| | - Papanin Putsathit
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Deirdre A Collins
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Thomas V Riley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical, Molecular and Forensic Sciences, Murdoch University, Perth, WA, Australia.,School of Biomedical Sciences, The University of Western Australia, Nedlands, WA, Australia.,PathWest Laboratory Medicine, Department of Microbiology, Nedlands, WA, Australia
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Risk Factors for Recurrence of Clostridioides difficile in Hospitalized Patients. J Infect Public Health 2021; 14:1642-1649. [PMID: 34627059 DOI: 10.1016/j.jiph.2021.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/02/2021] [Accepted: 09/16/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diarrhea and pseudomembranous colitis associated with Clostridioides difficile - a spore-forming anaerobic Gram-positive bacillus - is a major infection in hospitalized patients with a profound impact on clinical and economic outcomes. Recurrence (rCDI) is common and predisposes to further episodes with poor outcomes. METHOD We aimed to identify a wide range of risk factors for recurrence to guide stewardship initiatives. After ethical approval, we commenced collecting demographic and clinical data of patients older than 18 years with clinically and microbiologically confirmed C. difficile infection. Data were statistically analyzed using R software. RESULTS Of 204 patients included in the analysis, 36 (18%) suffered 90-day recurrence, rCDI was higher among females (23%) compared to males (13%), overall age median (IQR) was 66 (51-77), and for rCDI cases 81 (69-86) years. Among 26 variables analyzed to evaluate their association with rCDI, prior clindamycin exposure, concurrent use of aztreonam, patients >76 years, total hospital length of stay, and LOS before diagnosis ≤7 days, WBC ≤ 9.85 × 103 at discharge were more likely to experience rCDI. CONCLUSION As identified in this analysis, patients with risk factors for rCDI could be candidates for close monitoring, a high index of suspicion, and risk mitigation interventions to avoid rCDI and improve clinical outcomes.
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Clostridioides difficile infection and antibiotic prescription rates in the community: Explaining the gender gap. Infect Control Hosp Epidemiol 2020; 42:622-624. [PMID: 33239121 DOI: 10.1017/ice.2020.1268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In this cross-sectional population-based study, women had significantly higher crude incidence rates of both community-associated Clostridioides difficile infection (CA-CDI) and ambulatory antibiotic prescriptions compared to men in South Carolina in 2015. After adjustments for antibiotic prescription rates, there was no difference in the incidence rates of CA-CDI between the genders.
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O'Neal M, Murray H, Dash S, Al-Hasan MN, Justo JA, Bookstaver PB. Evaluating appropriateness and diagnostic stewardship opportunities of multiplex polymerase chain reaction gastrointestinal testing within a hospital system. Ther Adv Infect Dis 2020; 7:2049936120959561. [PMID: 33014363 PMCID: PMC7513010 DOI: 10.1177/2049936120959561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022] Open
Abstract
Objective: This single-center, retrospective, observational cohort study evaluates the
appropriateness of the BioFire® FilmArray® Gastrointestinal (GI) multiplex
PCR panel testing at a community-teaching hospital. Methods: All adult, hospitalized patients at Prisma Health Richland Hospital with a
documented GI multiplex PCR panel from 1 April 2015 through 28 February 2018
were included in the analysis. Inappropriate use of the GI panel was defined
as a test obtained without documented diarrhea, greater than 2 days of
hospitalization, redundant use with other diagnostic tests (e.g.
Clostridioides difficile PCR), or laxative use in the
preceding 48 h. Antibiotic use and host variables were compared between
groups with positive and negative results. Results: During the study period, 442 GI panels were obtained, among which 268 (61%)
were deemed inappropriate. Primary reasons for inappropriate testing were
lack of documented diarrhea (n = 92), greater than 2 days
of hospitalization (n = 116), having a duplicate C.
difficile PCR test ordered (n = 118), or
laxative use in the 48 h before testing (n = 36). A total
of 141 (32%) GI panels were positive. The most frequently identified
pathogens were C. difficile (51.1%,
n = 72), Enteropathogenic Escherichia coli
(17.7%, n = 25), and Norovirus GI/GII (12.1%,
n = 17). Patients with negative GI panel results were
initiated on antibiotics significantly less frequently than those with
positive GI panels (62.5% versus 80.2%,
p < 0.00001). Conclusion: Stewardship opportunities exist to optimize the diagnostic application of the
GI multiplex PCR panel.
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Affiliation(s)
- Melissa O'Neal
- University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA
| | - Hanna Murray
- University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Sangita Dash
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Majdi N Al-Hasan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Julie Ann Justo
- University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - P Brandon Bookstaver
- University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA
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Gulati M, Singh SK, Corrie L, Chandwani L, Singh A, Kapoor B, Kumar R, Pandey NK, Kumar B, Awasthi A, Khursheed R. Fecal Microbiota Transplant: Latest Addition to Arsenal Against Recurrent Clostridium Difficile Infection. RECENT PATENTS ON ANTI-INFECTIVE DRUG DISCOVERY 2020; 16:PRI-EPUB-110215. [PMID: 32981509 DOI: 10.2174/1574891x15666200925092354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022]
Abstract
An infectious disease of colon, recurrent Clostridium difficile infection (RCDI) is hitherto considered insurmountable leading to significant morbidity and mortality. Gut dysbiosis, generally resulting from frequent use of antibiotics is considered to be responsible for the etiopathogenesis of rCDI. Ironically, the conventional treatment strategies for the disease also include the use of anti-infective drugs such as metronidazole, vancomycin and fidaxomycin. As a result of the efforts to overcome the limitations of these treatment options to control recurrence of disease, Fecal Microbiota Transplant (FMT) has emerged as an effective and safe alternative. It is pertinent to add here that FMT is defined as the process of engraftment of fecal suspension from the healthy person into the gastrointestinal tract of the diseased individual aiming at the restoration of gut microbiota. FMT has proved to be quite successful in the treatment of recurrent and resistant Clostridium difficile infections (RCDI). In last three decades a lot of information has been generated on the use of FMT for RCDI. A number of clinical trials have been reported with generally very high success rates. However, very small number of patents could be found in the area indicating that there still exists lacuna in the knowledge about FMT with respect to its preparation, regulation, mode of delivery and safety. The current review attempts to dive deeper to discuss the patents available in the area while supporting the information contained therein with the non-patent literature.
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Affiliation(s)
- Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Sachin K Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Leander Corrie
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Lipika Chandwani
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Apoorva Singh
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh-160012. India
| | - Bhupinder Kapoor
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Rajesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Narendra K Pandey
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Ankit Awasthi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab- 144411. India
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Temporal trends in ambulatory antibiotic prescription rates in South Carolina: Impact of age, gender, and resident location. Infect Control Hosp Epidemiol 2020; 41:879-882. [PMID: 32498729 DOI: 10.1017/ice.2020.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the temporal trends in ambulatory antibiotic prescription fill rates and to determine the influences of age, gender, and location. DESIGN Population-based cohort study. SETTING Ambulatory setting in South Carolina. PATIENTS Patients ≤64 years of age from January 2012 to December 2017. METHODS Aggregated pharmacy claims data for oral antibiotic prescriptions were utilized to estimate community antibiotic prescription rates. Poisson regression or Student t tests were used to examine overall temporal trend in antibiotic prescription rates, seasonal variation, and the trends across age group, gender, and rural versus urban location. RESULTS Overall antibiotic prescription rates decrease from 1,127 to 897 per 1,000 person years (P < .001). The decrease was more noticeable in persons aged <18 years (26%) and 18-39 years (20%) than in those aged 40-64 years (5%; P < .001 for all). Prescription rates were higher among females than males in all age groups, although this finding was the most pronounced in group aged 18-39 years (1,232 vs 585 per 1,000 person years; P < .0001). Annualized antibiotic prescription rates were higher during the winter months (December-March) than the rest of the year (1,145 vs 885 per 1,000 person years; P < .0001), and rates were higher in rural areas than in urban areas (1,032 vs 941 per 1,000 person years; P < .0001). CONCLUSIONS The decline in ambulatory antibiotic prescription rates is encouraging. Ongoing ambulatory antibiotic stewardship efforts across South Carolina should focus on older adults, rural areas, and during the winter season when antibiotic prescriptions peak.
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