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Albiach L, Camprubí D, Alvarez-Martínez MJ, Soriano A. Ribotype 027 Clostridioides difficile infection presented as a traveller's diarrhoea. Enferm Infecc Microbiol Clin 2019; 38:196-197. [PMID: 31607397 DOI: 10.1016/j.eimc.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Laia Albiach
- Infectious Diseases Department, Hospital Clínic de Barcelona, Spain.
| | - Daniel Camprubí
- Tropical Medicine and International Health Department, Hospital Clínic de Barcelona, Spain; ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Miriam J Alvarez-Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Hospital Clínic de Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic de Barcelona, Spain
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Andrés Lasheras S, Martín Burriel I, Aspiroz C, Mainar Jaime RC, Robres P, Sevilla E, Kuijper E, Chirino Trejo M, Bolea R. Incidence and characterization of Clostridium difficile in a secondary care hospital in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:338-344. [PMID: 30569726 DOI: 10.17235/reed.2018.5288/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Clostridium difficile (C. difficile) is a major nosocomial infectious agent in hospitals. Previous studies have addressed the high proportion of infection episodes that are overlooked in health care facilities. OBJECTIVE the main aim of this study was to characterize C. difficile clinical cases that occurred in a secondary care hospital during a five-month period. MATERIAL AND METHODS for this purpose, a total of 137 stool samples from the same number of patients with diarrhea were analyzed for the presence of C. difficile by culture techniques. An enzyme immunoassay (EIA) test for the detection of C. difficile and its toxins was also used in 50 cases (36.5%) for diagnostic purposes. RESULTS a total of 14 (10.2%) C. difficile isolates were obtained, of which nine (64.3%) were toxigenic. A mean incidence of 3.2 episodes of C. difficile infections (CDI) per 10,000 patients-days was estimated for the study period. Around 56% of the CDI cases were determined as hospital-acquired, whereas 44% originated in the community. Among these, only two episodes (22.2%) were detected in the hospital by the EIA test, which indicated that the hospital CDI detection protocol needed to be revised. One unusual C. difficile isolate was negative for all toxin genes examined and also for the non-toxigenic strain assay, which highlights the need to perform genome sequencing to study its pathogenicity locus insertion site organization. A stable metronidazole-resistant C. difficile strain and three strains showing multidrug resistance were detected in this study, suggesting that C. difficile antimicrobial susceptibility surveillance programs should be established in this health-care facility.
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Affiliation(s)
- Sara Andrés Lasheras
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre, Canadá
| | - Inma Martín Burriel
- Laboratorio de Genética Bioquímica (LAGENBIO), Facultad de Veterinaria. Universidad de Zaragoza, España
| | - Carmen Aspiroz
- Sección de Microbiología y Parasitología, Hospital Royo Villanova, España
| | | | - Pilar Robres
- Sección de Microbiología y Parasitología, Hospital Royo Villanova, España
| | - Eloísa Sevilla
- Microbiología e Inmunología, Facultad de Veterinaria. Universidad de Zaragoza, España
| | - Ed Kuijper
- Department of Medical Microbiology, Centre of Infe, Leiden University Medical Centre, The Netherlands
| | - Manuel Chirino Trejo
- Department of Veterinary Microbiology, Western College of Veterinary Medicine. University of Saskatchewan, Canadá
| | - Rosa Bolea
- Microbiología e Inmunología, Facultad de Veterinaria. Universidad de Zaragoza, España
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Arca-Suárez J, Galán-Sánchez F, Cano-Cano F, García-Santos G, Rodríguez-Iglesias M. Antimicrobial susceptibility and molecular typing of toxigenic clinical isolates of Clostridium difficile causing infections in the south of Spain. Anaerobe 2018; 54:146-150. [DOI: 10.1016/j.anaerobe.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 02/08/2023]
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Gutiérrez-Pizarraya A, Martín-Villén L, Alcalá-Hernández L, Marín Arriaza M, Balandín-Moreno B, Aragón-González C, Ferreres-Franco J, Chiveli Monleón MÁ, Anguita-Alonso P, Bouza-Santiago E, Garnacho-Montero J. Epidemiology and risk factors for Clostridium difficile infection in critically ill patients in Spain: The PROCRID study. Enferm Infecc Microbiol Clin 2018; 36:218-221. [DOI: 10.1016/j.eimc.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/12/2022]
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An outbreak of Clostridium difficile PCR ribotype 027 in Spain: risk factors for recurrence and a novel treatment strategy. Eur J Clin Microbiol Infect Dis 2017; 36:1777-1786. [DOI: 10.1007/s10096-017-2991-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/17/2017] [Indexed: 12/15/2022]
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Alcalá Hernández L, Reigadas Ramírez E, Bouza Santiago E. Infección por Clostridium difficile. Med Clin (Barc) 2017; 148:456-463. [DOI: 10.1016/j.medcli.2017.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 01/22/2017] [Accepted: 01/29/2017] [Indexed: 12/17/2022]
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Esteban-Vasallo MD, Naval Pellicer S, Domínguez-Berjón MF, Cantero Caballero M, Asensio Á, Saravia G, Astray-Mochales J. Age and gender differences in Clostridium difficile-related hospitalization trends in Madrid (Spain) over a 12-year period. Eur J Clin Microbiol Infect Dis 2016; 35:1037-44. [PMID: 27056555 DOI: 10.1007/s10096-016-2635-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
This study aimed to analyze temporal trends by gender and age in Clostridium difficile infection (CDI)-related hospitalization rates in the Autonomous Community of Madrid (Spain) over a 12-year period. A population-based cross-sectional study of all hospital admissions with a CDI diagnosis from 2003 to 2014 was carried out. Annual age-specific hospitalization rates were calculated by gender. All the analyses were performed separately for total hospitalizations and hospitalizations with CDI as the primary diagnosis. Joinpoint regression models were used to analyze time trends. A total of 13,526 hospital discharges were identified (26.8 % with CDI as the primary diagnosis). In both sexes, a gradient in age-specific rates was observed, ranging in 2014 from 5.92 hospitalizations per 100,000 person-years in patients <15 years of age to 378.96 in patients ≥85 years of age. Since 2009, in the age group of 15-44 years, both men and women presented an increasing trend of around 18 %. A significantly increasing trend was detected in women of age 45-84 years, with an estimated annual percentage of change of 7.6 % in the age group of 45-64 years, and rounding with 4.5 % in the age group of 65-84 years. In men of age 45-64 years, the average annual percentage of increase was 4.7 %, and it was 21.1 % between 2010 and 2014 in the age group of 65-74 years. No trends were identified in the 85 years and over age group. Surveillance methods to assess trends by age group should be implemented. Preventive and therapeutic initiatives should remain a priority.
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Affiliation(s)
- M D Esteban-Vasallo
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain.
| | - S Naval Pellicer
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
| | - M F Domínguez-Berjón
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
| | - M Cantero Caballero
- Preventive Medicine Service, Puerta de Hierro-Majadahonda Hospital, Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - Á Asensio
- Preventive Medicine Service, Puerta de Hierro-Majadahonda Hospital, Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - G Saravia
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
| | - J Astray-Mochales
- Public Health Directorate, Madrid Regional Health Authority, San Martín de Porres, 6, 28035, Madrid, Spain
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Rodríguez-Martín C, Serrano-Morte A, Sánchez-Muñoz LA, de Santos-Castro PA, Bratos-Pérez MA, Ortiz de Lejarazu-Leonardo R. [Identifying gaps between guidelines and clinical practice in Clostridium difficile infection]. ACTA ACUST UNITED AC 2015; 31:152-8. [PMID: 26708998 DOI: 10.1016/j.cali.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The first aim was to determine whether patients are being treated in accordance with the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (IDSA/SHEA) Clostridium difficile guidelines and whether adherence impacts patient outcomes. The second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation. MATERIAL AND METHODS A retrospective, descriptive study was conducted over a 36 month period, on patients with compatible clinical symptoms and positive test for C. difficile toxins A and/or B in stool samples, in an internal medicine department of a tertiary medical centre. Patient demographic and clinical data (outcomes, comorbidity, risk factors) and compliance with guidelines, were examined RESULTS A total of 77 patients with C. difficile infection were identified (87 episodes). Stratified by disease severity criteria, 49.3% of patients were mild-moderate, 35.1% severe, and 15.6% severe-complicated. Full adherence with the guidelines was observed in only 40.2% of patients, and was significantly better for mild-moderate (71.0%), than in severe (7.4%) or severe-complicated patients (16.6%) (P<.003). Adherence was significantly associated with clinical cure (57% vs 42%), fewer recurrences (22.2% vs 77.7%), and mortality (25% vs 75%) (P<.01). The stratification of severity of the episode, and the adequacy of antibiotic to clinical severity, need improvement. CONCLUSIONS Overall adherence with the guidelines for management of Clostridium difficile infection was poor, especially in severe and severe-complicated patients, being associated with worse clinical outcomes. Educational interventions aimed at improving guideline adherence are warranted.
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Affiliation(s)
- C Rodríguez-Martín
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Serrano-Morte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - L A Sánchez-Muñoz
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - P A de Santos-Castro
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M A Bratos-Pérez
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Rodríguez-Villodres Á, Praena J, Vidal-Acuña MR, Aznar J. [Recurrent disease due to ribotype 027 Clostridium difficile]. Enferm Infecc Microbiol Clin 2015; 34:461-2. [PMID: 26620602 DOI: 10.1016/j.eimc.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Ángel Rodríguez-Villodres
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Julia Praena
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - María Reyes Vidal-Acuña
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Javier Aznar
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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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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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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Impact of clinical awareness and diagnostic tests on the underdiagnosis of Clostridium difficile infection. Eur J Clin Microbiol Infect Dis 2015; 34:1515-25. [PMID: 25904126 DOI: 10.1007/s10096-015-2380-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/31/2015] [Indexed: 12/18/2022]
Abstract
A multicenter study of Clostridium difficile infection (CDI) performed during 2008 in Spain revealed that two of every three episodes went undiagnosed or were misdiagnosed owing to nonsensitive diagnostic tests or lack of clinical suspicion and request. Since then, efforts have been made to improve the diagnostic tests used by laboratories and to increase the awareness of this disease among both clinicians and microbiologists. Our objective was to evaluate the impact of these efforts by assessing the current magnitude of underdiagnosis of CDI in Spain using two point-prevalence studies performed on one day each in January and July of 2013. A total of 111 Spanish laboratories selected all unformed stool specimens received for microbiological diagnosis on these days, and toxigenic culture was performed at a central reference laboratory. Toxigenic isolates were characterized both pheno- and genotypically. The reference laboratory detected 103 episodes of CDI in patients aged 2 years or more. Half (50.5 %) of the episodes were not diagnosed in the participating laboratories, owing to insensitive diagnostic tests (15.5 %) or the lack of clinical suspicion and request (35.0 %). The main ribotypes were 014, 078/126, 001/072, and 106. Ribotype 027 caused 2.9 % of all cases. Despite all the interventions undertaken, CDI remains a highly neglected disease because of the lack of sensitive diagnostic tests in some institutions and, especially, the absence of clinical suspicion, mainly in patients with community-associated CDI. Toxigenic C. difficile should be routinely sought in unformed stools sent for microbiological diagnosis, regardless of their origin.
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