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Kunishima H, Ohge H, Suzuki H, Nakamura A, Matsumoto K, Mikamo H, Mori N, Morinaga Y, Yanagihara K, Yamagishi Y, Yoshizawa S. Japanese Clinical Practice Guidelines for Management of Clostridioides (Clostridium) difficile infection. J Infect Chemother 2022; 28:1045-1083. [PMID: 35618618 DOI: 10.1016/j.jiac.2021.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, Japan.
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Hiromichi Suzuki
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Japan
| | - Atsushi Nakamura
- Division of Infection Control and Prevention, Nagoya City University Hospital, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Clinical Infectious Diseases, Graduate School of Medicine, Aichi Medical University, Japan
| | - Nobuaki Mori
- Division of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, Japan
| | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yuka Yamagishi
- Clinical Infectious Diseases, Graduate School of Medicine, Aichi Medical University, Japan
| | - Sadako Yoshizawa
- Department of Clinical Laboratory/Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
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Yokoyama Y, Shiota A, Asai N, Koizumi Y, Yamagishi Y, Sakanashi D, Nakamura A, Suematsu H, Ohnishi M, Mikamo H. Risk factors of first recurrence of Clostridioides difficile infection. Anaerobe 2022; 75:102556. [PMID: 35395406 DOI: 10.1016/j.anaerobe.2022.102556] [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: 06/13/2021] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Clostridioides difficile infection (CDI) often recurs. Approximately 25% of patients have recurrences after the initial treatment, and patients who have relapsed once are more likely to relapse. We aimed to identify the risk factors for initial CDI recurrence. METHODS We performed a retrospective survey of patient backgrounds and treatment-related factors. Risk factors were analyzed using single and multiple logistic regression analyses. RESULTS A total of 134 patients were included in the study. Prophylactic probiotic use and nasogastric tube feeding were independent risk factors for the initial recurrence of CDI. Patients using prophylactic probiotics had significantly higher recurrence rates than those not using prophylactic probiotics. CONCLUSION Prophylactic probiotic use and nasogastric tube placement may be risk factors for the initial recurrence of CDI. It is noteworthy that CDI that occurs during the use of prophylactic probiotics may be prone to recurrence.
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Affiliation(s)
- Yuki Yokoyama
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan; Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan
| | - Arufumi Shiota
- Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
| | - Nobuhiro Asai
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Akiko Nakamura
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroyuki Suematsu
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Masafumi Ohnishi
- Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan.
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Jordan S, Hui N, Doudle M, Von Papen M, Naik A, Lu CT, Nolan G, Cooper M. Incidence of Clostridioides difficile in patients post loop ileostomy reversal in an Australian tertiary hospital: a retrospective study. ANZ J Surg 2021; 92:403-408. [PMID: 34889019 DOI: 10.1111/ans.17411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The purpose of a loop ileostomy is to temporarily divert faeces away from a distal anastomosis, to reduce the consequences of anastomotic leak. This ultimately requires a second procedure to restore bowel continuity, which confers risk of complications including the development of Clostridioides difficile infection (CDI). It is hypothesized that patients who undergo loop ileostomy reversal are at increased risk of CDI when compared with other patients undergoing elective colorectal surgical procedures, and that these patients also experience an increased length of stay (LOS). METHODS A retrospective cohort study was performed on all patients who underwent loop ileostomy reversal at the Gold Coast Hospital and Health Service between 1 January 2012 and 31 December 2019. RESULTS Two hundred and twenty-eight patients were identified. Eight tested positive for CDI on faecal PCR (3.51%), a higher incidence than that in patients who underwent an elective colorectal surgical procedure during the same period (0.83%) (RR = 4.23). Additionally, median LOS for ileostomy reversal patients was significantly increased in those who also had CDI when compared with those without CDI (11 versus 4 days; P = 0.0003). CONCLUSION The study confirmed that the incidence of CDI was higher in those who underwent ileostomy reversal when compared with an otherwise comparable hospital population (elective colorectal surgery patients). Additionally, those patients who underwent ileostomy reversal and had CDI experienced an increased LOS which translates to increased cost to the healthcare system. Further investigation into pre-operative screening and prophylactic antibiotics should be considered as a measure to mitigate this post-operative complication.
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Affiliation(s)
- Stephanie Jordan
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nathan Hui
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Mark Doudle
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Von Papen
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Arun Naik
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Cu Tai Lu
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Gregory Nolan
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michelle Cooper
- Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
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Nehanda S, Mulundu G, Kelly P. Prevalence of Clostridium difficile and its toxins in hospital patients with diarrhoeal diseases in Lusaka, Zambia. Trans R Soc Trop Med Hyg 2021; 114:86-90. [PMID: 31608956 DOI: 10.1093/trstmh/trz074] [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: 01/15/2019] [Revised: 06/07/2019] [Accepted: 07/10/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) has emerged as an important nosocomial and antibiotic-associated diarrhoeal problem leading to increasing morbidity and mortality, especially in resource-privileged regions. CDI varies in incidence, pathogenicity and risk factors across geographical locations, yet little information is available on CDI in sub-Saharan Africa. This study aimed to determine the prevalence of Clostridium difficile and related toxin expression in stool specimens from patients with diarrhoeal disease at the University Teaching Hospital, Lusaka, Zambia. METHODS Between June and September 2017, patients presenting with acute or persistent diarrhoea provided stool samples that were cultured anaerobically on cycloserine cefoxitin fructose agar. Isolates were identified by Gram staining, C. difficile latex agglutination and confirmed by PCR targeting of the tpi housekeeping gene. Toxins A or B were detected by ELISA. RESULTS Of 135 participants enrolled, 13 (10%) were C. difficile positive, of which four (31%) were toxigenic by ELISA. Among HIV-positive and HIV-negative participants, the frequency of culturable C. difficile (19% vs 12%; p=0.17) and of toxigenic isolates (15% vs 0%, p=0.19) did not differ. CONCLUSIONS We can now revise previous research and confirm that CDI contributes to diarrhoea among hospitalised adult patients irrespective of HIV status.
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Affiliation(s)
- Shepherd Nehanda
- Department of Biomedical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Gina Mulundu
- Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | - Paul Kelly
- TROPGAN, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.,Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
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ASID/ACIPC position statement - Infection control for patients with Clostridium difficile infection in healthcare facilities. Infect Dis Health 2018; 24:32-43. [PMID: 30691583 DOI: 10.1016/j.idh.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2011, the Australasian Society for Infectious Diseases (ASID) and the Australian Infection Control Association (AICA), now known as the Australasian College of Infection Prevention and Control (ACIPC), produced a position statement on infection control requirements for preventing and controlling Clostridium difficile infection (CDI) in healthcare settings. METHODS The statement updated in 2017 to reflect new literature available .The authors reviewed the 2011 position statement and critically appraised new literature published between 2011 and 2017 and relevant current infection control guidelines to identify where new evidence had become available or best practice had changed. RESULTS The position statement was updated incorporating the new findings. A draft version of the updated position statement was circulated for consultation to members of ASID and ACIPC. The authors responded to all comments received and updated the position statement. CONCLUSIONS This updated position statement emphasizes the importance of health service organizations having evidence-based infection prevention and control programs and comprehensive antimicrobial stewardship programs, to ensure the risk of C. difficile acquisition, transmission and infection is minimised.
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Wijarnpreecha K, Sornprom S, Thongprayoon C, Phatharacharukul P, Cheungpasitporn W. Nasogastric tube and outcomes of Clostridium difficile infection: A systematic review and meta-analysis. J Evid Based Med 2018; 11:40-45. [PMID: 29322624 DOI: 10.1111/jebm.12288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 11/25/2017] [Indexed: 01/11/2023]
Abstract
AIMS Clostridium difficile infection (CDI) is a major concern for public health worldwide. Interestingly, the risk of poor clinical outcomes of CDI in patients with nasogastric tube (NGT) insertion is still controversial. The aim of this study was to assess the outcomes of CDI in patients with NGT insertion. METHODS A literature search was performed using MEDLINE, EMBASE, and The Cochrane Database of Systematic Reviews from inception through November 2017. Studies that reported relative risks, odds ratios, or hazard ratios comparing the clinical outcome of CDI in patients with NGT versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS Eight observational studies were included in our analysis to assess the association between NGT insertion and risk of poor outcome of CDI. The pooled RR of severe or complicated clinical outcomes of CDI in patients with NGT insertion was 1.81 (95% CI: 1.17 to 2.81). CONCLUSIONS This study demonstrated a statistically significant association between NGT insertion and risk of poor outcomes of CDI. This finding may impact clinical management and primary prevention of CDI. Avoidance of unnecessary NGT uses would improve the clinical outcomes of CDI.
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Affiliation(s)
- Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Suthanya Sornprom
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
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Salazar CL, Reyes C, Atehortua S, Sierra P, Correa MM, Paredes-Sabja D, Best E, Fawley WN, Wilcox M, González Á. Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia. PLoS One 2017; 12:e0184689. [PMID: 28902923 PMCID: PMC5597206 DOI: 10.1371/journal.pone.0184689] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022] Open
Abstract
In Colombia, the epidemiology and circulating genotypes of Clostridium difficile have not yet been described. Therefore, we molecularly characterized clinical isolates of C.difficile from patients with suspicion of C.difficile infection (CDI) in three tertiary care hospitals. C.difficile was isolated from stool samples by culture, the presence of A/B toxins were detected by enzyme immunoassay, cytotoxicity was tested by cell culture and the antimicrobial susceptibility determined. After DNA extraction, tcdA, tcdB and binary toxin (CDTa/CDTb) genes were detected by PCR, and PCR-ribotyping performed. From a total of 913 stool samples collected during 2013-2014, 775 were included in the study. The frequency of A/B toxins-positive samples was 9.7% (75/775). A total of 143 isolates of C.difficile were recovered from culture, 110 (76.9%) produced cytotoxic effect in cell culture, 100 (69.9%) were tcdA+/tcdB+, 11 (7.7%) tcdA-/tcdB+, 32 (22.4%) tcdA-/tcdB- and 25 (17.5%) CDTa+/CDTb+. From 37 ribotypes identified, ribotypes 591 (20%), 106 (9%) and 002 (7.9%) were the most prevalent; only one isolate corresponded to ribotype 027, four to ribotype 078 and four were new ribotypes (794,795, 804,805). All isolates were susceptible to vancomycin and metronidazole, while 85% and 7.7% were resistant to clindamycin and moxifloxacin, respectively. By multivariate analysis, significant risk factors associated to CDI were, staying in orthopedic service, exposure to third-generation cephalosporins and staying in an ICU before CDI symptoms; moreover, steroids showed to be a protector factor. These results revealed new C. difficile ribotypes and a high diversity profile circulating in Colombia different from those reported in America and European countries.
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Affiliation(s)
- Clara Lina Salazar
- Research Group in Anaerobic Bacteria (GIBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Catalina Reyes
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | | | - Patricia Sierra
- Clínica León XIII, IPS Universitaria, Universidad de Antioquia, Medellín, Colombia
| | - Margarita María Correa
- Molecular Microbiology Group, School of Microbiology, Universidad de Antioquia, Medellín, Colombia
| | - Daniel Paredes-Sabja
- Microbiota-Host Interactions and Clostridia Research Group, Departamento de Ciencias Biológicas, at Universidad Andres Bello, Santiago, Chile
| | - Emma Best
- Departament of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Warren N. Fawley
- Departament of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mark Wilcox
- Departament of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ángel González
- Basic and Applied Microbiology Research Group (MICROBA), School of Microbiology, Universidad de Antioquia, Medellín, Colombia
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Clostridium difficile disease: Diagnosis, pathogenesis, and treatment update. Surgery 2017; 162:325-348. [DOI: 10.1016/j.surg.2017.01.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/16/2022]
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[Clinical and demographic profile and risk factors for Clostridium difficile infection]. BIOMEDICA 2017; 37:53-61. [PMID: 28527248 DOI: 10.7705/biomedica.v37i1.2915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 05/24/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease. OBJECTIVE To determine the clinical characteristics of hospitalized patients with C. difficile infection. MATERIALS AND METHODS We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications. RESULTS We collected data from 123 patients during the follow-up period, 30 of whom were positive for the toxin. Mean age in the study population was 49 years and 60% were men. The main symptoms were abdominal pain (35%) and fever (34%). The principal complications were electrolytic alteration and severe sepsis with secondary acute kidney injury. Mortality was 13% and independent factors associated to the appearance of the infection were the use of proton pump inhibitors and previous gastrointestinal tract surgery. CONCLUSIONS The use of proton pump inhibitors and previous gastrointestinal tract surgery were factors associated to C. difficile infection.
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