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Cha JM, Yoon JY, Kwak MS, Lee M, Cho YS. Demographic Characteristics and Economic Burden of Clostridioides difficile Infection in Korea: A Nationwide Population-Based Study after Propensity Score Matching. Antibiotics (Basel) 2024; 13:542. [PMID: 38927208 PMCID: PMC11201190 DOI: 10.3390/antibiotics13060542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Clostridioides difficile infection (CDI) poses a considerable threat to global public health. However, there have been insufficient propensity score-matched data on its demographic characteristics and economic burden. Using nationwide claims data, we assessed longitudinal changes in the demographic characteristics and economic burden of CDI between 2011 and 2019 after propensity score matching. We performed a regression analysis to compare the differences in the length of hospital stay and medical costs between patients with CDI and controls (gastroenteritis and colitis). The CDI hospitalization rate increased 2.9-fold between 2011 and 2019. The CDI group had higher comorbidity index scores and was more frequently diagnosed at tertiary hospitals and in the Seoul region than the control group (all p < 0.001). The annual incidence rate of CDI/10,000 persons significantly increased in both sexes and all age groups. The length of hospital stay and medical costs were 3.3-fold and 5.0-fold greater, respectively, in the CDI than in the control group (both p < 0.001). Although the length of hospital stay decreased, total medical costs increased in all age groups and both sexes between 2011 and 2019 (all p < 0.001). When compared with the control group, the CDI-attributable length of hospital stay and medical cost were greater by 15.3 days and KRW 3413 (×103), respectively, after matching. In conclusion, CDI incidence, particularly among the elderly population with comorbidities, has been increasing. In addition, the length of hospital stay and total medical costs of the CDI group were greater than those of the control group.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea; (J.Y.Y.); (M.S.K.); (M.L.)
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea; (J.Y.Y.); (M.S.K.); (M.L.)
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea; (J.Y.Y.); (M.S.K.); (M.L.)
| | - Moonhyung Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea; (J.Y.Y.); (M.S.K.); (M.L.)
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Li Z, Ouyang Z, Zhang H, Mi C, Dong N, Niu Y, Qiang C, Yang J, Wang W, Li Y, Zhao J. Novel target and PCR assay for identification of hypervirulent ST1 (BI/NAP1/027) Clostridioides difficile and detection of toxigenic C. Difficile. Clin Chim Acta 2024; 559:119728. [PMID: 38750779 DOI: 10.1016/j.cca.2024.119728] [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: 04/22/2024] [Accepted: 05/12/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND AND AIMS The incidence of Clostridioides difficile infection and the prevalence of hypervirulent ST1 (BI/NAP1/027)strain are increasing, especially in developing countries. We aimed to develop a new PCR assay for the identification of hypervirulent ST1 strains and toxigenic C. difficile in stool samples. MATERIALS AND METHODS We established a quadruplex TaqMan real-time PCR (pilW_4-plex PCR) assay targeting the pilW, a ST1-specific type Ⅳ minor pilin gene, and three C. difficile genes including cdtB, tcdB, and hsp. The sensitivity and specificity of the assay was tested using 403C. difficile isolates and 180 unformed stool sample. The results were compared with anaerobic culture-based conventional PCR method and MLST. RESULTS The pilW_4-plex PCR identified toxigenic C. difficile in 333 (82.6%, 333/403) isolates with 100% sensitivity and specificity, and in 78 (43.3%, 78/180) stool samples with the sensitivity and specificity of 94.7% and 93.3%, respectively. Hypervirulent ST1 were detected in 21 strains and nine stool samples by the pilW_4-plex PCR. The pilW_4-plex PCR assay has no cross-reaction with non-toxigenic C. difficile or other bacteria. CONCLUSION The pilW_4-plex PCR assay is an accurate and rapid method with high sensitivity and specificity for identification of ST1 and detection of toxigenic C. difficile in stool.
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Affiliation(s)
- Zhirong Li
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zirou Ouyang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huimin Zhang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chaoyi Mi
- Research Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China; Clinical Oncology Research Center, Shijiazhuang, China Key Laboratory of Tumor Gene Diagnosis, Prevention and Therapy; Clinical Oncology Research Center, Shijiazhuang, ChinaClinical Oncology Research Center, Shijiazhuang, China
| | - Ning Dong
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanan Niu
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cuixin Qiang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Yang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weigang Wang
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanhong Li
- Comprehensive Surgical Department, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jianhong Zhao
- Hebei Provincial Center for Clinical Laboratories, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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Kim J, Myung R, Kim B, Kim J, Kim T, Lee MS, Kim UJ, Park DW, Kim YS, Lee CS, Kim ES, Lee SH, Chang HH, Lee SS, Park SY, Choi HJ, Kim HI, Ha YE, Wi YM, Choi S, Shin SY, Pai H. Incidence of Clostridioides difficile Infections in Republic of Korea: A Prospective Study With Active Surveillance vs. National Data From Health Insurance Review & Assessment Service. J Korean Med Sci 2024; 39:e118. [PMID: 38565175 PMCID: PMC10985502 DOI: 10.3346/jkms.2024.39.e118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. METHODS To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. RESULTS In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patient-days was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25-12.05) and 4.18 per 1,000 admissions (range: 1.92-8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68-13.90) and 6.73 per 1,000 admissions (range: 3.18-15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. CONCLUSION The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.
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Affiliation(s)
- Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Rangmi Myung
- Department of Non-benefits Management, National Health Insurance Service, Wonju, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | | | - Tark Kim
- Divison of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Mi Suk Lee
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Yeon-Sook Kim
- Division of Infectious Diseases, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chang-Seop Lee
- Department of Internal Medicine and Research Institute of Clinical Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Soon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Se Yoon Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye In Kim
- Department of Infectious Diseases, Daegu Fatima Hospital, Daegu, Korea
| | - Young Eun Ha
- Department of Infectious Diseases, Bucheon Sejong Hospital, Bucheon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea
| | - Sungim Choi
- Division of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang, Korea
| | - So Youn Shin
- Department of Infectious Diseases, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Cui Y, Zhang C, Jia Q, Gong X, Tan Y, Hua X, Jian W, Yang S, Hayer K, Raja Idris RK, Zhang Y, Wu Y, Tu Z. An epidemiological surveillance study (2021-2022): detection of a high diversity of Clostridioides difficile isolates in one tertiary hospital in Chongqing, Southwest China. BMC Infect Dis 2023; 23:703. [PMID: 37858038 PMCID: PMC10588108 DOI: 10.1186/s12879-023-08666-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Clostridioides difficile is a bacterium that causes antibiotic-associated infectious diarrhea and pseudomembranous enterocolitis. The impact of C. difficile infection (CDI) in China has gained significant attention in recent years. However, little epidemiological data are available from Chongqing, a city located in Southwest China. This study aimed to investigate the epidemiological pattern of CDI and explore the drug resistance of C. difficile isolates in Chongqing. METHODS A case-control study was conducted to investigate the clinical infection characteristics and susceptibility factors of C. difficile. The features of the C. difficile isolates were evaluated by testing for toxin genes and using multi-locus sequence typing (MLST). The susceptibility of strains to nine antibiotics was determined using agar dilution technique. RESULTS Out of 2084 diarrhea patients, 90 were tested positive for the isolation of toxigenic C. difficile strains, resulting in a CDI prevalence rate of 4.32%. Tetracycline, cephalosporins, hepatobiliary disease, and gastrointestinal disorders were identified as independent risk factors for CDI incidence. The 90 strains were classified into 21 sequence types (ST), with ST3 being the most frequent (n = 25, 27.78%), followed by ST2 (n = 10, 11.11%) and ST37 (n = 9, 10%). Three different toxin types were identified: 69 (76.67%) were A+B+CDT-, 12 (13.33%) were A-B+CDT-, and 9 (10%) were A+B+CDT+. Although substantial resistance to erythromycin (73.33%), moxifloxacin (62.22%), and clindamycin (82.22%), none of the isolates exhibited resistance to vancomycin, tigecycline, or metronidazole. Furthermore, different toxin types displayed varying anti-microbial characteristics. CONCLUSIONS The strains identified in Chongqing, Southwest China, exhibited high genetic diversity. Enhance full awareness of high-risk patients with HA-CDI infection, particularly those with gastrointestinal and hepatocellular diseases, and emphasize caution in the use of tetracycline and capecitabine. These findings suggest that a potential epidemic of CDI may occur in the future, emphasizing the need for timely monitoring.
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Affiliation(s)
- Yihong Cui
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China
| | - Chuanming Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Qianying Jia
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Xue Gong
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China
| | - Yu Tan
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China
| | - Xinping Hua
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China
| | - Wenwen Jian
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China
| | - Shenglin Yang
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China
| | - Kim Hayer
- Leicester Medical School, University of Leicester, LE1 7RH, Leicester, UK
| | | | - Yi Zhang
- International Medical College, Chongqing Medical University, 400016, Chongqing, China
| | - Yuan Wu
- State Key Laboratory of Infectious Disease Prevention and Control, National Insti for Communicable Disease Control and Prevention, Chinese Center for Disease Prevention and Control, 102206, Beijing, China
| | - Zeng Tu
- Department of Pathogen Biology, College of Basic Medical Science, Chongqing Medical University, 400016, Chongqing, China.
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Carling PC, Parry MF, Olmstead R. Environmental approaches to controlling Clostridioides difficile infection in healthcare settings. Antimicrob Resist Infect Control 2023; 12:94. [PMID: 37679758 PMCID: PMC10483842 DOI: 10.1186/s13756-023-01295-z] [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: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
As today's most prevalent and costly healthcare-associated infection, hospital-onset Clostridioides difficile infection (HO-CDI) represents a major threat to patient safety world-wide. This review will discuss how new insights into the epidemiology of CDI have quantified the prevalence of C. difficile (CD) spore contamination of the patient-zone as well as the role of asymptomatically colonized patients who unavoidable contaminate their near and distant environments with resilient spores. Clarification of the epidemiology of CD in parallel with the development of a new generation of sporicidal agents which can be used on a daily basis without damaging surfaces, equipment, or the environment, led to the research discussed in this review. These advances underscore the potential for significantly mitigating HO-CDI when combined with ongoing programs for optimizing the thoroughness of cleaning as well as disinfection. The consequence of this paradigm-shift in environmental hygiene practice, particularly when combined with advances in hand hygiene practice, has the potential for significantly improving patient safety in hospitals globally by mitigating the acquisition of CD spores and, quite plausibly, other environmentally transmitted healthcare-associated pathogens.
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Boyanova L, Dimitrov G, Gergova R, Hadzhiyski P, Markovska R. Clostridioides difficile resistance to antibiotics, including post-COVID-19 data. Expert Rev Clin Pharmacol 2023; 16:925-938. [PMID: 37642560 DOI: 10.1080/17512433.2023.2252331] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Updating data on Clostridioides difficile antibiotic resistance is important for treatment improvement of C. difficile infections (CDIs). AREAS COVERED Results from 20 countries were included. The mean resistance to 2 mg/l vancomycin, 2 mg/l metronidazole, 4 mg/l moxifloxacin, and 4 mg/l clindamycin was 4.7% (0 to ≥ 26% in two studies), 2.6% (0 to ≥ 40% in 3 studies), 34.9% (6.6->80%), and 61.0% (30->90%), respectively. Resistance to erythromycin (>60-88%), rifampin (>23-55.0%), imipenem (0.6 to > 78% in a clone), tigecycline (0-<5.0%), and fidaxomicin (0-2%) was also found. Resistance to ≥ 5 antibiotics of different classes was reported in some countries. High resistance and multidrug resistance were observed in hypervirulent and epidemic strains. Although only 1% of COVID-19 patients had CDIs, the proportion might be underestimated. EXPERT OPINION C. difficile antimicrobial susceptibility varied by country/region, study period, and circulating ribotypes. For CDI treatment, fidaxomicin (preferably) or vancomycin is recommended, while metronidazole is suitable for mild infections. New approaches, including biotherapeutics (Rebyota), strains, antibiotics (ridinilazole and ibezapolstat), and monoclonal antibodies/cocktails merit further evaluation. Because of the resistance rate variations, C. difficile antibiotic susceptibility should be regularly monitored. Post-COVID-19 resistance should be separately presented. Some discrepancies between vancomycin and metronidazole results need to be clarified.
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Affiliation(s)
- Lyudmila Boyanova
- Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Georgi Dimitrov
- Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Raina Gergova
- Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Petyo Hadzhiyski
- Specialized Hospital for Active Pediatric Treatment, Medical University of Sofia, Sofia, Bulgaria
| | - Rumyana Markovska
- Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
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Wen BJ, Dong N, Ouyang ZR, Qin P, Yang J, Wang WG, Qiang CX, Li ZR, Niu YN, Zhao JH. Prevalence and molecular characterization of Clostridioides difficile infection in China over the past 5 years: a systematic review and meta-analysis. Int J Infect Dis 2023; 130:86-93. [PMID: 36906122 DOI: 10.1016/j.ijid.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/10/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES The aim of this study was to provide an overview of the prevalence and molecular characteristics of Clostridioides difficile infection (CDI) in China in the past 5 years. METHODS A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Nine databases were searched for relevant studies published between January 2017 and February 2022. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of included studies, and R software version 4.1.3 was used for data analysis. Funnel plots and Egger regression tests were also performed to assess publication bias. RESULTS A total of 50 studies were included in the analysis. The pooled prevalence of CDI in China was 11.4% (2696/26,852). The main circulating C. difficile strains in southern China were ST54, ST3, and ST37, consistent with the overall situation in China. However, the most prevalent genotype in northern China was ST2, which was previously underappreciated. CONCLUSION Based on our findings, increased awareness and management of CDI is necessary to reduce the prevalence of CDI in China.
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Affiliation(s)
- Bao-Jiang Wen
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Ning Dong
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Zi-Rou Ouyang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Pu Qin
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Jing Yang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Wei-Gang Wang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Cui-Xin Qiang
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Zhi-Rong Li
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Ya-Nan Niu
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China
| | - Jian-Hong Zhao
- The Second Hospital of Hebei Medical University, Shijiazhuang, China; Hebei Provincial Center for Clinical Laboratories, Shijiazhuang, China.
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Du T, Choi KB, Silva A, Golding GR, Pelude L, Hizon R, Al-Rawahi GN, Brooks J, Chow B, Collet JC, Comeau JL, Davis I, Evans GA, Frenette C, Han G, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Hota SS. Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015-2019. Emerg Infect Dis 2022; 28:1128-1136. [PMID: 35470794 PMCID: PMC9155897 DOI: 10.3201/eid2806.212262] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015–2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015–2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.
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Predicting adjacent infections in pediatric septic arthritis: Do predictive criteria extrapolate across geographic regions?: Predicting Periarticular Infection in the Southeast. J Orthop 2021; 28:53-57. [PMID: 34840482 DOI: 10.1016/j.jor.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose This study aims to assess previously determined predictive criteria for presence of adjacent infection in septic arthritis within a Southeastern United States (US) pediatric population. Results The sensitivity, specificity, positive predictive value, and negative predictive value of the Rosenfeld criteria were: 91.7%, 22.7%, 39.3%, and 83.3%, respectively. The patients with periarticular infection were more likely to have positive blood cultures than those with isolated septic arthritis. There was no difference in likelihood of secondary surgical intervention. Conclusions Previously defined criteria to predict adjacent infection in pediatric septic arthritis did not demonstrate external validity in a Southeastern US pediatric population.
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10
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Change in trends of hospitalizations and deaths with mention of Clostridioides difficile infection in northeastern Italy, 2008-2019. Infect Control Hosp Epidemiol 2021; 43:1512-1513. [PMID: 34323212 DOI: 10.1017/ice.2021.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ho J, Changbunjong T, Weluwanarak T, Hussain S, Sparagano O. The pests of a pest: A systematic review of ectoparasitic fauna among synanthropic rodents in the 21st century with meta-analysis. Acta Trop 2021; 215:105802. [PMID: 33352168 DOI: 10.1016/j.actatropica.2020.105802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 12/30/2022]
Abstract
Synanthropic rodents are important urban pests that frequently carry hematophagous ectoparasites. These blood-sucking pests are capable of transmitting epizootic and zoonotic pathogens by landing on one host after feeding on an infected animal. This study aimed to estimate the prevalence of ectoparasites carried by synanthropic rodents and discuss the pathogens that are associated with these external parasites. We searched relevant literatures using predefined criteria in the following databases: EMBASE, PUBMED, Web of Science and Scopus from January 2000 to June 2020. Quality of studies was evaluated using Newcastle-Ottawa scale (NOS). Of 35 included studies from 15 countries in Africa, America, Asia, Europe and Oceania, black rats (R. rattus), brown rats (R. norvegicus), pacific rats (R. exulans) and house mice (Mus musculus) were common synanthropic rodents. Mites (Mesostigmata, Sarcoptiformes and Trombidiformes) were the most prevalent (42.6%, 95% CI 26-59.2), followed by ticks (Ixodida) (21.5%, 95% CI 10.5-32.6), lice (Phthiraptera) (17.8%, 95% CI 7.7-27.9) and fleas (Siphonaptera) (14.1%, 95% CI 10.1-18.1). Heterogeneity (I2>96%) across studies was statistically significant. The ectoparasitic fauna was shared considerably by different urban rodent species and appeared to be more diverse in R. rattus and R. norvegicus. Nonetheless, pathogens carried by these ectoparasites were rarely investigated. In conclusion, ectoparasites are ubiquitous in urban-dwelling rodents but our understanding of the epidemiology and the associated pathogens of these parasites remains limited. Further studies are warranted to unravel the pathogen landscape found in rodent-associated ectoparasites.
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Affiliation(s)
- Jeffery Ho
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China.
| | - Tanasak Changbunjong
- Department of Pre-clinic and Applied Animal Science, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand; The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals (MoZWE), Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Thekhawet Weluwanarak
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals (MoZWE), Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Sabir Hussain
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China; Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Olivier Sparagano
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
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Ballo O, Kreisel EM, Eladly F, Brunnberg U, Stratmann J, Hunyady P, Hogardt M, Wichelhaus TA, Kempf VAJ, Steffen B, Vehreschild JJ, Vehreschild MJGT, Finkelmeier F, Serve H, Brandts CH. Use of carbapenems and glycopeptides increases risk for Clostridioides difficile infections in acute myeloid leukemia patients undergoing intensive induction chemotherapy. Ann Hematol 2020; 99:2547-2553. [PMID: 32974837 PMCID: PMC7536157 DOI: 10.1007/s00277-020-04274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/17/2020] [Indexed: 10/25/2022]
Abstract
Patients with acute myeloid leukemia (AML) are often exposed to broad-spectrum antibiotics and thus at high risk of Clostridioides difficile infections (CDI). As bacterial infections are a common cause for treatment-related mortality in these patients, we conducted a retrospective study to analyze the incidence of CDI and to evaluate risk factors for CDI in a large uniformly treated AML cohort. A total of 415 AML patients undergoing intensive induction chemotherapy between 2007 and 2019 were included in this retrospective analysis. Patients presenting with diarrhea and positive stool testing for toxin-producing Clostridioides difficile were defined to have CDI. CDI was diagnosed in 37 (8.9%) of 415 AML patients with decreasing CDI rates between 2013 and 2019 versus 2007 to 2012. Days with fever, exposition to carbapenems, and glycopeptides were significantly associated with CDI in AML patients. Clinical endpoints such as length of hospital stay, admission to ICU, response rates, and survival were not adversely affected. We identified febrile episodes and exposition to carbapenems and glycopeptides as risk factors for CDI in AML patients undergoing induction chemotherapy, thereby highlighting the importance of interdisciplinary antibiotic stewardship programs guiding treatment strategies in AML patients with infectious complications to carefully balance risks and benefits of anti-infective agents.
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Affiliation(s)
- Olivier Ballo
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
| | - Eva-Maria Kreisel
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Fagr Eladly
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Uta Brunnberg
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Jan Stratmann
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Peter Hunyady
- Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,University Center for Infectious Diseases, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,University Center of Competence for Infection Control, Frankfurt - Giessen -, Marburg, Hessen, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,University Center for Infectious Diseases, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,University Center of Competence for Infection Control, Frankfurt - Giessen -, Marburg, Hessen, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,University Center for Infectious Diseases, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,University Center of Competence for Infection Control, Frankfurt - Giessen -, Marburg, Hessen, Germany
| | - Björn Steffen
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joerg J Vehreschild
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Maria J G T Vehreschild
- University Center for Infectious Diseases, Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - Fabian Finkelmeier
- Department of Medicine, Gastroenterology, Hepatology and Endocrinology, University Hospital, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.,Frankfurt Cancer Institute, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian H Brandts
- Department of Medicine, Hematology/Oncology, University Hospital, Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany. .,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany. .,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.
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Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2014-2018. ACTA ACUST UNITED AC 2020; 46:99-112. [PMID: 32558807 DOI: 10.14745/ccdr.v46i05a01] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose serious threats to the health of Canadians due to increased morbidity, mortality and healthcare costs. Epidemiologic and laboratory surveillance data, collected through the Canadian Nosocomial Infection Surveillance Program, are used to inform infection prevention and control and antimicrobial stewardship programs and policies. The objective of this study was to describe the epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2014 to 2018 using surveillance data provided by Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Methods Data were collected from 70 Canadian sentinel hospitals between January 1, 2014 and December 31, 2018 for Clostridioides difficile infection (CDI), methicillin-resistant Staphylococcus aureus bloodstream infections, vancomycin-resistant Enterococci bloodstream infections and carbapenemase-producing Enterobacteriaceae. Case counts, rates, outcome data, molecular characterization and antimicrobial resistance profiles are presented. Additionally, hospital-level Escherichia coli antibiogram data were collected and are described. Results Increases in rates per 10,000 patient-days were observed for methicillin-resistant S. aureus bloodstream infections (59%; 0.66-1.05, p=0.023) and vancomycin-resistant Enterococci bloodstream infections (143%; 0.14-0.34, p=0.023). However, CDI rates decreased by 12.5% between 2015 and 2018 (from 6.16-5.39, p=0.042). Carbapenemase-producing Enterobacteriaceae infection rates remained low and stable whereas colonization increased by 375% (0.04-0.19; p=0.014). Conclusion Ongoing efforts to prevent HAIs and reduce AMR in Canada require consistent, standardized surveillance data from acute care hospitals. Increased collaboration with provincial, territorial and international partners in infection prevention and control, as well as antimicrobial stewardship, will be essential in reducing the burden of observed HAIs (including antimicrobial resistant organisms).
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