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Navarathna T, Chatterjee P, Choi H, Coppin JD, Corona B, Brackens E, Mayo L, Hwang M, Williams M, Bennett M, Jinadatha C. Efficacy of copper-impregnated antimicrobial surfaces against Clostridioides difficile spores. Infect Control Hosp Epidemiol 2024; 46:1-7. [PMID: 39703079 PMCID: PMC11790332 DOI: 10.1017/ice.2024.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 11/18/2024] [Accepted: 11/20/2024] [Indexed: 12/21/2024]
Abstract
OBJECTIVE Clostridioides difficile (C. difficile) is one of the most common causes of healthcare-associated infections (HAIs). Elimination of C. difficile spores is difficult as they are resistant to common hospital-grade disinfectants. Copper-impregnated surfaces provide continuous reduction of multiple pathogens, potentially lowering the risk of infections. This manuscript aims to evaluate the efficacy of copper-impregnated surfaces on C. difficile spores. METHODS Control (no copper) coupons and copper coupons containing 20% copper-oxide were inoculated with C. difficile spore loads ranging from 105 to 107 spores, with or without 5% fetal bovine serum soil load. After 4 hours of contact time, the C. difficile spores were recovered, plated on C. difficile growth media, and colony forming units were counted. The efficacy of copper (log10 kill) was estimated using a Bayesian latent variables model. RESULTS After 4 hours, unsoiled copper bedrail and copper table coupons at mean spore inoculation resulted in a 97.3% and 96.8% reduction in spore count (1.57 and 1.50 log10 kill, respectively). That of soiled bedrail and table coupons showed a 91.8% and 91.7% reduction (1.10 and 1.10 log10 kill, respectively). CONCLUSIONS Copper coupons can substantially reduce C. difficile spores after 4 hours, but results vary depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent spores from contact with copper surfaces, thus decreasing kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces may decrease spore burden and help prevent transmission of spores.
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Affiliation(s)
- Thanuri Navarathna
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Piyali Chatterjee
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Hosoon Choi
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - John D Coppin
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Brandon Corona
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Emma Brackens
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Lynn Mayo
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Munok Hwang
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Marjory Williams
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Morgan Bennett
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Chetan Jinadatha
- Department of Medicine, Central Texas Veterans Health Care System, Temple, TX, USA
- Department of Medical Education, College of Medicine, Texas A&M University, Bryan, TX, USA
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Kramer A, Lexow F, Bludau A, Köster AM, Misailovski M, Seifert U, Eggers M, Rutala W, Dancer SJ, Scheithauer S. How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by "fomite-borne risk assessment". Clin Microbiol Rev 2024; 37:e0018623. [PMID: 39388143 PMCID: PMC11640306 DOI: 10.1128/cmr.00186-23] [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] [Indexed: 10/15/2024] Open
Abstract
SUMMARYIn healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of contamination, infectious dose (ID), virulence, hygiene practices, and patient vulnerability. This review attempts to close a gap in previous reviews on persistence/tenacity by only including articles (n = 171) providing quantitative data on re-cultivable pathogens from fomites for a better translation into clinical settings. We have therefore introduced the new term "replication capacity" (RC). The RC is affected by the degree of contamination, surface material, temperature, relative humidity, protein load, organic soil, UV-light (sunlight) exposure, and pH value. In general, investigations into surface RC are mainly performed in vitro using reference strains with high inocula. In vitro data from studies on 14 Gram-positive, 26 Gram-negative bacteria, 18 fungi, 4 protozoa, and 37 viruses. It should be regarded as a worst-case scenario indicating the upper bounds of risks when using such data for clinical decision-making. Information on RC after surface contamination could be seen as an opportunity to choose the most appropriate infection prevention and control (IPC) strategies. To help with decision-making, pathogens characterized by an increased nosocomial risk for transmission from inanimate surfaces ("fomite-borne") are presented and discussed in this systematic review. Thus, the review offers a theoretical basis to support local risk assessments and IPC recommendations.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene
and Environmental Medicine, University Medicine
Greifswald, Greifswald,
Germany
| | - Franziska Lexow
- Department for
Infectious Diseases, Unit 14: Hospital Hygiene, Infection Prevention and
Control, Robert Koch Institute,
Berlin, Germany
| | - Anna Bludau
- Department of
Infection Control and Infectious Diseases, University Medical Center
Göttingen (UMG), Georg-August University
Göttingen,
Göttingen, Germany
| | - Antonia Milena Köster
- Department of
Infection Control and Infectious Diseases, University Medical Center
Göttingen (UMG), Georg-August University
Göttingen,
Göttingen, Germany
| | - Martin Misailovski
- Department of
Infection Control and Infectious Diseases, University Medical Center
Göttingen (UMG), Georg-August University
Göttingen,
Göttingen, Germany
- Department of
Geriatrics, University of Göttingen Medical
Center, Göttingen,
Germany
| | - Ulrike Seifert
- Friedrich
Loeffler-Institute of Medical Microbiology – Virology, University
Medicine Greifswald,
Greifswald, Germany
| | - Maren Eggers
- Labor Prof. Dr. G.
Enders MVZ GbR, Stuttgart,
Germany
| | - William Rutala
- Division of Infectious
Diseases, University of North Carolina School of
Medicine, Chapel Hill,
North Carolina, USA
| | - Stephanie J. Dancer
- Department of
Microbiology, University Hospital
Hairmyres, Glasgow,
United Kingdom
- School of Applied
Sciences, Edinburgh Napier University,
Edinburgh, United Kingdom
| | - Simone Scheithauer
- Department of
Infection Control and Infectious Diseases, University Medical Center
Göttingen (UMG), Georg-August University
Göttingen,
Göttingen, Germany
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3
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Adhikari S, Anthony S, Baleinamau P, Coriakula J, Daurewa T, Devi R, Gavidi S, Horwitz P, Hunter EC, Jenkins A, Jupiter S, Lalamacuata M, Mailautoka K, Mangubhai S, Naivalu K, Naivalulevu T, Naivalulevu V, Nasim N, Naucunivanua S, Negin J, van Nimwegen P, Ratu A, Ravoka M, Tukana A, van de Vossenberg J, Wilson D, Thomas J. An assessment of latrine front-end characteristics and associated surface E. coli indicated faecal contamination in rural Fiji. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:52948-52962. [PMID: 39164561 PMCID: PMC11379791 DOI: 10.1007/s11356-024-34668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/05/2024] [Indexed: 08/22/2024]
Abstract
In Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This specific research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and to assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline (n = 311) (Aug-Dec 2019), endline (n = 262) (Jun-Sep 2022) and an in-depth front-end study (n = 12) (Oct-Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 102 CFU/25 cm2) compared to non-washable floors (1.3 × 102 CFU/25 cm2) (p = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 103 CFU/25 cm2) compared to the dry ones (14.3 CFU/25 cm2) (p < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use.
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Affiliation(s)
- Sabita Adhikari
- School of Civil Engineering, The University of Sydney, Darlington, NSW, 2006, Australia.
| | - Shylett Anthony
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Ponipate Baleinamau
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Jeremaia Coriakula
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Thompson Daurewa
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Rachel Devi
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Sikeli Gavidi
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Pierre Horwitz
- Centre for People, Place, and Planet, Edith Cowan University, Joondalup, WA, Australia
| | - Erin C Hunter
- Department of Public Health Sciences, College of Behavioural, Social and Health Sciences, Clemson University, Clemson, USA
| | - Aaron Jenkins
- Centre for People, Place, and Planet, Edith Cowan University, Joondalup, WA, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Stacy Jupiter
- Wildlife Conservation Society, Melanesia Program, Suva, Fiji
| | - Maria Lalamacuata
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Kinikoto Mailautoka
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Sangeeta Mangubhai
- Wildlife Conservation Society, Fiji Program, Suva, Fiji
- Talanoa Consulting, 42 Knollys Street, Suva, Fiji
| | - Kelera Naivalu
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Timoci Naivalulevu
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Vilisi Naivalulevu
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Nabeela Nasim
- School of Civil Engineering, The University of Sydney, Darlington, NSW, 2006, Australia
| | | | - Joel Negin
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | | | - Anaseini Ratu
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Mereia Ravoka
- Wildlife Conservation Society, Fiji Program, Suva, Fiji
| | - Andrew Tukana
- Wildlife Conservation Society, Fiji Program, Suva, Fiji
| | - Jack van de Vossenberg
- Water Supply, Sanitation and Environmental Engineering Department, IHE Delft Institute of Water Education, Delft, The Netherlands
| | - Donald Wilson
- Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University, Hoodless House, Suva, Fiji
| | - Jacqueline Thomas
- School of Civil Engineering, The University of Sydney, Darlington, NSW, 2006, Australia
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Kunishima H, Ichiki K, Ohge H, Sakamoto F, Sato Y, Suzuki H, Nakamura A, Fujimura S, Matsumoto K, Mikamo H, Mizutani T, Morinaga Y, Mori M, Yamagishi Y, Yoshizawa S. Japanese Society for infection prevention and control guide to Clostridioides difficile infection prevention and control. J Infect Chemother 2024; 30:673-715. [PMID: 38714273 DOI: 10.1016/j.jiac.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University Hospital, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Fumie Sakamoto
- Quality Improvement and Safety Center, Itabashi Chuo Medical Center, Japan
| | - Yuka Sato
- Department of Infection Control and Nursing, Graduate School of Nursing, Aichi Medical University, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, University of Tsukuba School of Medicine and Health Sciences, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases and Chemotherapy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | | | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Sadako Yoshizawa
- Department of Laboratory Medicine/Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Japan
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5
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Porter L, Sultan O, Mitchell BG, Jenney A, Kiernan M, Brewster DJ, Russo PL. How long do nosocomial pathogens persist on inanimate surfaces? A scoping review. J Hosp Infect 2024; 147:25-31. [PMID: 38447803 DOI: 10.1016/j.jhin.2024.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Healthcare hygiene plays a crucial role in the prevention of healthcare-associated infections. Patients admitted to a room where the previous occupant had a multi-drug-resistant bacterial infection are at an increased risk of colonization and infection with the same organism. A 2006 systematic review by Kramer et al. found that certain pathogens can survive for months on dry surfaces. The aim of this review is to update Kramer et al.'s previous review and provide contemporary data on the survival of pathogens relevant to the healthcare environment. We systematically searched Ovid MEDLINE, CINAHL and Scopus databases for studies that described the survival time of common nosocomial pathogens in the environment. Pathogens included in the review were bacterial, viral, and fungal. Studies were independently screened against predetermined inclusion/exclusion criteria by two researchers. Conflicts were resolved by one of two senior researchers. A spreadsheet was developed for the data extraction. The search identified 1736 studies. Following removal of duplicates and application of the search criteria, the synthesis of results from 62 included studies were included. 117 organisms were reported. The longest surviving organism reported was Klebsiella pneumoniae which was found to have persisted for 600 days. Common pathogens of concern to infection prevention and control, can survive or persist on inanimate surfaces for months. This data supports the need for a risk-based approach to cleaning and disinfection practices, accompanied by appropriate training, audit and feedback which are proven to be effective when adopted in a 'bundle' approach.
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Affiliation(s)
- L Porter
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - O Sultan
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - B G Mitchell
- School of Nursing, Avondale University, Wahroonga, Australia; School of Nursing and Midwifery, Monash University, Clayton, Australia; School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - A Jenney
- Microbiology Unit, Alfred Health, Prahran, Australia
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - D J Brewster
- Central Clinical School, Monash University, Clayton, Australia; Intensive Care Unit, Cabrini Health, Malvern, Australia
| | - P L Russo
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia; School of Nursing, Avondale University, Wahroonga, Australia.
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6
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Zhang M, Tang H, Chen Y, Chen Z, Xu Y, Fu X, Sun Y, Zhao Z. Impact of environmental characteristics on children's gut microbiota - A pilot study in assessing the role of indoor microbiome and metabolites. ENVIRONMENTAL RESEARCH 2023; 234:116114. [PMID: 37209986 DOI: 10.1016/j.envres.2023.116114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND A diverse and balanced human gut microbiota is crucial for maintaining normal human physiological functions. However, the impact of indoor microbiome and metabolites on gut microbiota is not well understood. METHODS A self-administered questionnaire was used to collect information on more than 40 personal and environmental characteristics and dietary habits from 56 children in Shanghai, China. Shotgun metagenomics and untargeted liquid chromatography-mass spectrometry (LC-MS) were used to characterize the indoor microbiome and metabolomic/chemical exposure in children's living rooms. PacBio full-length 16 S rRNA sequencing was used to characterize children's gut microbiota. Associations between environmental characteristics and gut microbiota diversity/composition were assessed using PERMANOVA and regression. RESULTS In total, 6247 and 318 indoor and gut microbial species and 1442 indoor metabolites were characterized. Age of children (R2 = 0.033, p = 0.008), age start kindergarten (R2 = 0.029, p = 0.03), living adjacent to heavy traffic (R2 = 0.031, p = 0.01) and drinking soft drinks (R2 = 0.028, p = 0.04) significantly impacted overall gut microbial composition, consistent with previous studies. Having pets/plants and frequent vegetable intake were positively associated with gut microbiota diversity and the Gut Microbiome Health Index (GMHI), while frequent juice and fries intake decreased gut microbiota diversity (p < 0.05). The abundance of indoor Clostridia and Bacilli was positively associated with gut microbial diversity and GMHI (p < 0.01). Total indoor indole derivatives and 6 indole metabolites (L-tryptophan, indole, 3-methylindole, indole-3-acetate, 5-hydroxy-L-tryptophan and indolelactic acid, p < 0.05) were positively associated with the abundance of total protective gut bacteria, suggesting a potential role in promoting gut health. Neural network analysis revealed that these indole derivatives were derived from indoor microorganisms. CONCLUSIONS The study is the first to report associations between indoor microbiome/metabolites and gut microbiota, highlighting the potential role of indoor microbiome in shaping human gut microbiota.
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Affiliation(s)
- Mei Zhang
- Guangdong Provincial Key Laboratory of Protein Function and Regulation in Agricultural Organisms, College of Life Sciences, South China Agricultural University, Guangzhou, 510642, Guangdong, PR China
| | - Hao Tang
- School of Public Health, Fudan University, Shanghai, 200032, PR China
| | - Yang Chen
- Guangdong Provincial Key Laboratory of Protein Function and Regulation in Agricultural Organisms, College of Life Sciences, South China Agricultural University, Guangzhou, 510642, Guangdong, PR China
| | - Zhuoru Chen
- Children's Hospital of Fudan University, Shanghai, 201102, PR China
| | - Yanyi Xu
- School of Public Health, Fudan University, Shanghai, 200032, PR China
| | - Xi Fu
- School of Public Health, Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, Guangdong Pharmaceutical University, Guangzhou, 510006, PR China
| | - Yu Sun
- Guangdong Provincial Key Laboratory of Protein Function and Regulation in Agricultural Organisms, College of Life Sciences, South China Agricultural University, Guangzhou, 510642, Guangdong, PR China.
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, 200032, PR China; Key Laboratory of Public Health Safety of the Ministry of Education, NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, PR China.
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7
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Rohde AM, Mischnik A, Behnke M, Dinkelacker A, Eisenbeis S, Falgenhauer J, Gastmeier P, Häcker G, Herold S, Imirzalioglu C, Käding N, Kramme E, Peter S, Piepenbrock E, Rupp J, Schneider C, Schwab F, Seifert H, Steib-Bauert M, Tacconelli E, Trauth J, Vehreschild MJGT, Walker SV, Kern WV, Jazmati N. Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019. J Antimicrob Chemother 2023; 78:2274-2282. [PMID: 37527398 DOI: 10.1093/jac/dkad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting. METHODS Monthly ward-level antibiotic consumption measured in DDD/100 patient days (pd) and CDI surveillance data from five university hospitals in the period 2017 through 2019 were analysed. Uni- and multivariable analyses were performed with generalized estimating equation models. RESULTS A total of 225 wards with 7347 surveillance months and 4 036 602 pd participated. With 1184 HAHO-CDI cases, there was a median incidence density of 0.17/1000 pd (IQR 0.03-0.43) across all specialties, with substantial differences among specialties. Haematology-oncology wards showed the highest median incidence density (0.67/1000 pd, IQR 0.44-1.01), followed by medical ICUs (0.45/1000 pd, IQR 0.27-0.73) and medical general wards (0.32/1000 pd, IQR 0.18-0.53). Multivariable analysis revealed carbapenem (mostly meropenem) consumption to be the only antibiotic class associated with increased HAHO-CDI incidence density. Each carbapenem DDD/100 pd administered increased the HAHO-CDI incidence density by 1.3% [incidence rate ratio (IRR) 1.013; 95% CI 1.006-1.019]. Specialty-specific analyses showed this influence only to be valid for haematological-oncological wards. Overall, factors like ward specialty (e.g. haematology-oncology ward IRR 2.961, 95% CI 2.203-3.980) or other CDI cases on ward had a stronger influence on HAHO-CDI incidence density (e.g. community-associated CDI or unknown association case in same month IRR 1.476, 95% CI 1.242-1.755) than antibiotic consumption. CONCLUSIONS In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI.
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Affiliation(s)
- Anna M Rohde
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Alexander Mischnik
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Michael Behnke
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Ariane Dinkelacker
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Simone Eisenbeis
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Jane Falgenhauer
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Petra Gastmeier
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Georg Häcker
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Susanne Herold
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- University Hospital Giessen and Marburg, Department of Medicine V (Internal Medicine, Infectious Diseases and Infection Control), Justus-Liebig-University Giessen, Giessen, Germany, member of the German Centre for Lung Research (DZL), member of the German Centre for Infection Research (DZIF) Department of Internal Medicine (Infectiology)
| | - Can Imirzalioglu
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Nadja Käding
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
| | - Evelyn Kramme
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Ellen Piepenbrock
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Rupp
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany
| | - Christian Schneider
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frank Schwab
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michaela Steib-Bauert
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Janina Trauth
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- University Hospital Giessen and Marburg, Department of Medicine V (Internal Medicine, Infectious Diseases and Infection Control), Justus-Liebig-University Giessen, Giessen, Germany, member of the German Centre for Lung Research (DZL), member of the German Centre for Infection Research (DZIF) Department of Internal Medicine (Infectiology)
| | - Maria J G T Vehreschild
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt am Main, Germany
| | - Sarah V Walker
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Winfried V Kern
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Nathalie Jazmati
- German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Labor Dr. Wisplinghoff, Cologne, Germany
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8
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Miller AC, Arakkal AT, Sewell DK, Segre AM, Tholany J, Polgreen PM, CDC MInD-Healthcare Group. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis 2023; 10:ofad413. [PMID: 37622034 PMCID: PMC10444966 DOI: 10.1093/ofid/ofad413] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
Background Antibiotics are the greatest risk factor for Clostridioides difficile infection (CDI). Risk for CDI varies across antibiotic types and classes. Optimal prescribing and stewardship recommendations require comparisons of risk across antibiotics. However, many prior studies rely on aggregated antibiotic categories or are underpowered to detect significant differences across antibiotic types. Using a large database of real-world data, we evaluate community-associated CDI risk across individual antibiotic types. Methods We conducted a matched case-control study using a large database of insurance claims capturing longitudinal health care encounters and medications. Case patients with community-associated CDI were matched to 5 control patients by age, sex, and enrollment period. Antibiotics prescribed within 30 days before the CDI diagnosis along with other risk factors, including comorbidities, health care exposures, and gastric acid suppression were considered. Conditional logistic regression and a Bayesian analysis were used to compare risk across individual antibiotics. A sensitivity analysis of antibiotic exposure windows between 30 and 180 days was conducted. Results We identified 159 404 cases and 797 020 controls. Antibiotics with the greatest risk for CDI included clindamycin and later-generation cephalosporins, and those with the lowest risk included minocycline and doxycycline. We were able to differentiate and order individual antibiotics in terms of their relative level of associated risk for CDI. Risk estimates varied considerably with different exposure windows considered. Conclusions We found wide variation in CDI risk within and between classes of antibiotics. These findings ordering the level of associated risk across antibiotics can help inform tradeoffs in antibiotic prescribing decisions and stewardship efforts.
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Affiliation(s)
- Aaron C Miller
- University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Alan T Arakkal
- University of Iowa, College of Public Health, Iowa City, Iowa, USA
| | - Daniel K Sewell
- University of Iowa, College of Public Health, Iowa City, Iowa, USA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, Iowa, USA
| | - Joseph Tholany
- University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Philip M Polgreen
- University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
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9
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Elfanagely YM, Tanzer JR, Shobayo A, Mohamed MF, Ho JJ, Shemin D, Pavlech L, D’Agata EM. Prevalence and trends of Clostridioides difficile infection among persons requiring maintenance hemodialysis: A systematic review and meta-analysis. Infect Control Hosp Epidemiol 2023; 44:1068-1075. [PMID: 36148878 PMCID: PMC10369223 DOI: 10.1017/ice.2022.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Clostridioides difficile infection (CDI) is among the most common cause of healthcare-associated infections. Persons requiring maintenance hemodialysis (MHD) are at increased risk of CDI and associated mortality compared to persons not requiring MHD. Given the clinical impact of CDI among persons requiring MHD, we aimed to quantify the burden of CDI and trends over time in this patient population. STUDY DESIGN A systematic review and meta-analysis of studies reporting rates of CDI among persons requiring MHD in MEDLINE, Embase, Web of Science Core Collection, CINAHL, and Cochrane Central Register of Controlled Trials were performed. Searches were conducted on May 17, 2021, and March 4, 2022. RESULTS In total, 2,408 titles and abstracts were identified; 240 underwent full text review. Among them, 15 studies provided data on rates of CDI among persons requiring MHD, and 8 of these also provided rates among persons not requiring MHD. The pooled prevalence of CDI among persons requiring MHD was 19.14%, compared to 5.16% among persons not requiring MHD (odds ratio [OR], 4.35; 95% confidence interval [CI], 2.07-9.16; P = .47). The linear increase in CDI over time was significant, increasing an average of 31.97% annually between 1993 and 2017 (OR, 1.32; 95% CI, 1.1-1.58; P < .01). The linear annual increase was similar among persons requiring and not requiring MHD (OR, 1.28; 95% CI, 1.13-1.45; P = .11). CONCLUSIONS Persons requiring MHD have a 4-fold higher risk of CDI compared to persons not requiring MHD, and rates of CDI are increasing over time in both groups.
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Affiliation(s)
- Yousef M. Elfanagely
- Department of Internal Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Joshua Ray Tanzer
- Department of Biostatistics, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Anuoluwapo Shobayo
- Division of Infectious Diseases, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Mouhand F.H. Mohamed
- Department of Internal Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jonathan J.C. Ho
- Department of Internal Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Douglas Shemin
- Division of Nephrology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | | | - Erika M.C. D’Agata
- Department of Biostatistics, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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10
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Freier L, Zacharias N, Gemein S, Gebel J, Engelhart S, Exner M, Mutters NT. Environmental Contamination and Persistence of Clostridioides difficile in Hospital Wastewater Systems. Appl Environ Microbiol 2023; 89:e0001423. [PMID: 37071016 PMCID: PMC10231184 DOI: 10.1128/aem.00014-23] [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: 01/09/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
Clostridioides difficile produces an environmentally resistant dormant spore morphotype that infected patients shed to the hospital environment. C. difficile spores persist in clinical reservoirs that are not targeted by hospital routine cleaning protocols. Transmissions and infections from these reservoirs present a hazard to patient safety. This study aimed to assess the impact of patients acutely suffering from C. difficile-associated diarrhea (CDAD) on C. difficile environmental contamination to identify potential reservoirs. Twenty-three hospital rooms accommodating CDAD inpatients with corresponding soiled workrooms of 14 different wards were studied in a German maximum-care hospital. Additionally, four rooms that never accommodated CDAD patients were examined as negative controls. Stagnant water and biofilms from sinks, toilets, and washer disinfector (WD) traps as well as swabs from cleaned bedpans and high-touch surfaces (HTSs) were sampled. For detection, a culture method was used with selective medium. A latex agglutination assay and a Tox A/B enzyme-linked immunosorbent assay were performed with suspect colonies. Stagnant water and biofilms in hospital traps (29%), WDs (34%), and HTSs (37%) were found to be reservoirs for large amounts of C. difficile during the stay of CDAD inpatients that decreased but could persist 13 ± 6 days after their discharge (13%, 14%, and 9.5%, respectively). Control rooms showed none or only slight contamination restricted to WDs. A short-term cleaning strategy was implemented that reduced C. difficile in stagnant water almost entirely. IMPORTANCE Wastewater pipes are microbial ecosystems. The potential risk of infection emanating from the wastewater for individuals is often neglected, since it is perceived to remain in the pipes. However, sewage systems start with siphons and are thus naturally connected to the outside world. Wastewater pathogens do not only flow unidirectionally to wastewater treatment plants but also retrogradely, e.g., through splashing water from siphons to the hospital environment. This study focused on the pathogen C. difficile, which can cause severe and sometimes fatal diarrheas. This study shows how patients suffering from such diarrheas contaminate the hospital environment with C. difficile and that contamination persists in siphon habitats after patient discharge. This might pose a health risk for hospitalized patients afterward. Since this pathogen's spore morphotype is very environmentally resistant and difficult to disinfect, we show a cleaning measure that can almost entirely eliminate C. difficile from siphons.
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Affiliation(s)
- Lia Freier
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Stefanie Gemein
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
- Reference Institute for Bioanalytics, Bonn, Germany
| | - Jürgen Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nico T. Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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11
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Evidence of within-facility patient-patient Clostridiodes difficile infection spread across diverse settings. Epidemiol Infect 2022; 151:e4. [PMID: 36502810 PMCID: PMC9990401 DOI: 10.1017/s0950268822001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Previous studies have suggested that a hospital patient's risk of developing healthcare facility-onset (HCFO) Clostridioides difficile infections (CDIs) increases with the number of concurrent spatially proximate patients with CDI, termed CDI pressure. However, these studies were performed either in a single institution or in a single state with a very coarse measure of concurrence. We conducted a retrospective case-control study involving over 17.5 million inpatient visits across 700 hospitals in eight US states. We built a weighted, directed network connecting overlapping inpatient visits to measure facility-level CDI pressure. We then matched HCFO-CDIs with non-CDI controls on facility, comorbidities and demographics and performed a conditional logistic regression to determine the odds of developing HCFO-CDI given the number of coincident patient visits with CDI. On average, cases' visits coincided with 9.2 CDI cases, which for an individual with an average length of stay corresponded to an estimated 17.7% (95% CI 12.9-22.7%) increase in the odds of acquiring HCFO-CDI compared to an inpatient visit without concurrent CDI cases or fully isolated from both direct and indirect risks from concurrent CDI cases. These results suggest that, either directly or indirectly, hospital patients with CDI lead to CDIs in non-infected patients with temporally overlapping visits.
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12
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Wen GL, Li SH, Qin Z, Yang YJ, Bai LX, Ge WB, Liu XW, Li JY. Isolation, molecular typing and antimicrobial resistance of Clostridium difficile in dogs and cats in Lanzhou city of Northwest China. Front Vet Sci 2022; 9:1032945. [DOI: 10.3389/fvets.2022.1032945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/31/2022] [Indexed: 11/20/2022] Open
Abstract
Clostridium difficile infection (CDI) in human and animals belonged usually to antibiotic-associated diarrhea, ranging in severity from mild to life-threatening intestinal tract illnesses. This study aimed to isolation and characterization, toxin genes test, molecular typing, and drug sensitivity of Clostridium difficile (C. difficile) which were isolated from clinical diseased dogs and cats. A total of 247 clinical samples were collected from five animal hospitals in Lanzhou City of Northwest China, of which dogs and cats accounted for 74.9% (185/247) and 25.1% (62/247), respectively. We successfully identified 24 C. difficile strains by 16S rRNA and Matrix-Assisted Laser Desorption/Ionization Time of Fight Mass Spectroscopy (MALDI-TOF-MS). 10.3% (19/185) of dogs and 8.1% (5/62) of cats were positive for C. difficile. Among them, 16 strains were toxic and 8 were non-toxic, with a toxic rate of 57.9% (11/19) in dogs and 100% (5/5) in cats. A total of 10 STs and 10 RTs were identified in this study. The percentages of ST42 (RT106) and ST2 (RT014/LW01) among 16 toxic strains were 41.7 and 12.5%, respectively. However, ST3 (RT001), ST1 (RT027), ST133 (LW04), and ST-UN (LW04) had only one strain. ST42 (RT106) was the most common genotype and RT027 strain was first isolated in China from pets. Antimicrobial susceptibility test showed that isolates were extremely sensitive to vancomycin and metronidazole but were resistant to erythromycin and ciprofloxacin. The drug resistant rates to clindamycin, levofloxacin, moxifloxacin and meropenem were 62.5, 20.8, 16.7, and 8.3%, respectively. In conclusion, C. difficile was quietly prevalent in dogs and cats in Lanzhou city with RT106 and RT014 as the main ribotypes. The CDI in pets should be paying more attention and further studies are needed.
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13
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Ziegler MJ, Babcock HH, Welbel SF, Warren DK, Trick WE, Tolomeo P, Omorogbe J, Garcia D, Habrock-Bach T, Donceras O, Gaynes S, Cressman L, Burnham JP, Bilker W, Reddy SC, Pegues D, Lautenbach E, Kelly BJ, Fuchs B, Martin ND, Han JH. Stopping Hospital Infections With Environmental Services (SHINE): A Cluster-randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-resistant Organisms in the Intensive Care Unit. Clin Infect Dis 2022; 75:1217-1223. [PMID: 35100614 PMCID: PMC9525084 DOI: 10.1093/cid/ciac070] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) frequently contaminate hospital environments. We performed a multicenter, cluster-randomized, crossover trial of 2 methods for monitoring of terminal cleaning effectiveness. METHODS Six intensive care units (ICUs) at 3 medical centers received both interventions sequentially, in randomized order. Ten surfaces were surveyed each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services staff in real time with failing surfaces recleaned. We measured monthly rates of MDRO infection or colonization, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and MDR gram-negative bacilli (MDR-GNB) during a 12-month baseline period and sequential 6-month intervention periods, separated by a 2-month washout. Primary analysis compared only the randomized intervention periods, whereas secondary analysis included the baseline. RESULTS The ATP method was associated with a reduction in incidence rate of MDRO infection or colonization compared with the UV/F period (incidence rate ratio [IRR] 0.876; 95% confidence interval [CI], 0.807-0.951; P = .002). Including the baseline period, the ATP method was associated with reduced infection with MDROs (IRR 0.924; 95% CI, 0.855-0.998; P = .04), and MDR-GNB infection or colonization (IRR 0.856; 95% CI, 0.825-0.887; P < .001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turnaround time increased by a median of 1 minute with the ATP intervention and 4.5 minutes with UV/F compared with baseline. CONCLUSIONS Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a reduction of MDRO infection and colonization.
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Affiliation(s)
- Matthew J Ziegler
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hilary H Babcock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Sharon F Welbel
- Cook County Health, Chicago, Illinois, USA
- Rush Medical College, Chicago, Illinois, USA
| | - David K Warren
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - William E Trick
- Cook County Health, Chicago, Illinois, USA
- Rush Medical College, Chicago, Illinois, USA
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Tracy Habrock-Bach
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Steven Gaynes
- Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Leigh Cressman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason P Burnham
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Warren Bilker
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Pegues
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan J Kelly
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barry Fuchs
- Division of Pulmonary Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Niels D Martin
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer H Han
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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14
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Alves F, Nunes A, Castro R, Sequeira A, Moreira O, Matias R, Rodrigues JC, Silveira L, Gomes JP, Oleastro M. Assessment of the Transmission Dynamics of Clostridioides difficile in a Farm Environment Reveals the Presence of a New Toxigenic Strain Connected to Swine Production. Front Microbiol 2022; 13:858310. [PMID: 35495679 PMCID: PMC9050547 DOI: 10.3389/fmicb.2022.858310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/21/2022] [Indexed: 01/05/2023] Open
Abstract
The recent increase in community-acquired Clostridioides difficile infections discloses the shift in this bacterium epidemiology. This study aimed at establishing a transmission network involving One Health components, as well as assessing the zoonotic potential and genomic features of dominant clones. Samples were collected from different compartments of animal, human and environmental origin, from an animal production unit. C. difficile isolates were characterized for toxigenic profile by multiplex-PCR, while genetic diversity was evaluated by PCR-ribotyping and whole genome-based analysis. The overall C. difficile prevalence was 37.2% (70/188), and included samples from environmental (58.3%, 35/60) and animal (31.5%, 35/111) compartments; human samples (n = 17) taken from healthy workers were negative. A predominant clone from RT033 was found in almost 90% of the positive samples, including samples from all compartments connected to the pig production unit, with core-genome single nucleotide variant (SNV)-based Analysis supporting a clonal transmission between them (mean distance of 0.1 ± 0.1 core-SNVs). The isolates from this clone (herein designated PT RT033) were positive for all C. difficile toxin genes (tcdA, tcdB, cdtA/cdtB). The phyloGenetic positioning of this clone was clearly distinct from the classical RT033 cluster, suggesting a different evolutionary route. This new clone shares genomic features with several RTs from the clade 5 Sequence Type (ST) 11, including a complete pathogenicity locus (PaLoc) that is more similar to the one found in toxigenic strains and contrasting to the less virulent classical RT033 (tcdA-, tcdB-, cdtA + /cdtB +). The presence of a tcdA gene truncated into two ORFs, not previously described, requires further evaluation concerning toxin functionality. We hypothesize that the unique combination of genetic elements found in the PT RT033 clone may contribute to host tropism and environmental dissemination and maintenance. This study constitutes the first report of a toxigenic RT033 clone and adds to the overall knowledge on Clade 5 sequence type 11, considered the C. difficile evolutionary lineage with the highest zoonotic potential. The presence of this clone in all compartments associated with the pig production unit suggests a transmission chain involving these animals and contributes to unveil the role played by animal and environmental reservoirs in this pathogen epidemiology.
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Affiliation(s)
- Frederico Alves
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - Alexandra Nunes
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Lisbon, Portugal
- CBIOS – Lusófona University Research Centre for Biosciences & Health Technologies, Lisbon, Portugal
| | - Rita Castro
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - António Sequeira
- National Zootechnical Station, National Institute for Agrarian and Veterinarian Research, Santarém, Portugal
| | - Olga Moreira
- National Zootechnical Station, National Institute for Agrarian and Veterinarian Research, Santarém, Portugal
| | - Rui Matias
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - João Carlos Rodrigues
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - Leonor Silveira
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - João Paulo Gomes
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Lisbon, Portugal
| | - Mónica Oleastro
- Infectious Diseases Department, National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
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15
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Durant DJ, Young CG. Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State. J Patient Saf 2022; 18:e508-e513. [PMID: 34009865 DOI: 10.1097/pts.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clostridioides difficile is the most common hospital-acquired pathogen and persists in the environment for extended periods. As a common entry point for patients with diarrhea, and a setting providing fast-paced, high-volume care, emergency departments (EDs) are often sites of C. difficile contamination. This study examined the relationship between average patient wait times in the ED before admission and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals. METHODS A random-effects regression analysis compared each facility's annual average ED wait time for admitted patients with that facility's average (HA-CDI) rates for patients entering through the ED. This model controlled for known clinical and nonclinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age. RESULTS Emergency department wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional 0.002 cases of HA-CDI per 1000 patient discharges with every additional minute patients spend in the ED (P = 0.003), on average. Emergency department wait times also had the largest effect size (0.210), indicating that they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI. CONCLUSIONS The relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.
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Williamson CHD, Stone NE, Nunnally AE, Roe CC, Vazquez AJ, Lucero SA, Hornstra H, Wagner DM, Keim P, Rupnik M, Janezic S, Sahl JW. Identification of novel, cryptic Clostridioides species isolates from environmental samples collected from diverse geographical locations. Microb Genom 2022; 8. [PMID: 35166655 PMCID: PMC8942030 DOI: 10.1099/mgen.0.000742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clostridioides difficile is a pathogen often associated with hospital-acquired infection or antimicrobial-induced disease; however, increasing evidence indicates infections can result from community or environmental sources. Most genomic sequencing of C. difficile has focused on clinical strains, although evidence is growing that C. difficile spores are widespread in soil and water in the environment. In this study, we sequenced 38 genomes collected from soil and water isolates in Flagstaff (AZ, USA) and Slovenia in an effort targeted towards environmental surveillance of C. difficile. At the average nucleotide identity (ANI) level, the genomes were divergent to C. difficile at a threshold consistent with different species. A phylogenetic analysis of these divergent genomes together with Clostridioides genomes available in public repositories confirmed the presence of three previously described, cryptic Clostridioides species and added two additional clades. One of the cryptic species (C-III) was almost entirely composed of Arizona and Slovenia genomes, and contained distinct sub-groups from each region (evidenced by SNP and gene-content differences). A comparative genomics analysis identified multiple unique coding sequences per clade, which can serve as markers for subsequent environmental surveys of these cryptic species. Homologues to the C. difficile toxin genes, tcdA and tcdB, were found in cryptic species genomes, although they were not part of the typical pathogenicity locus observed in C. difficile, and in silico PCR suggested that some would not amplify with widely used PCR diagnostic tests. We also identified gene homologues in the binary toxin cluster, including some present on phage and, for what is believed to be the first time, on a plasmid. All isolates were obtained from environmental samples, so the function and disease potential of these toxin homologues is currently unknown. Enzymatic profiles of a subset of cryptic isolates (n=5) demonstrated differences, suggesting that these isolates contain substantial metabolic diversity. Antimicrobial resistance (AMR) was observed across a subset of isolates (n=4), suggesting that AMR mechanisms are intrinsic to the genus, perhaps originating from a shared environmental origin. This study greatly expands our understanding of the genomic diversity of Clostridioides. These results have implications for C. difficile One Health research, for more sensitive C. difficile diagnostics, as well as for understanding the evolutionary history of C. difficile and the development of pathogenesis.
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Affiliation(s)
| | - Nathan E Stone
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Amalee E Nunnally
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Chandler C Roe
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Adam J Vazquez
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Samantha A Lucero
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Heidie Hornstra
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - David M Wagner
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Paul Keim
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
| | - Maja Rupnik
- National Laboratory for Health, Environment and Food, Prvomajska Ulica 1, 2000 Maribor, Slovenia
| | - Sandra Janezic
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
| | - Jason William Sahl
- Pathogen and Microbiome Institute, Northern Arizona University, PO Box 4073, Flagstaff, AZ 86011, USA
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17
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Danehower S, Lazorko J, Kaplan LJ, Fegley M, Jablonski J, Owei L, Ziegler MJ, Pisa M, Pegues D, Pascual JL. Certain Rooms in Intensive Care Units May Harbor Risk for Clostridioides difficile Infection. Surg Infect (Larchmt) 2022; 23:159-167. [PMID: 35020481 DOI: 10.1089/sur.2021.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Background: Clostridioides difficile infection (CDI) is a common and sometimes life-threatening illness. Patient-, care-, and room hygiene-specific factors are known to impact CDI genesis, but care provider training and room topography have not been explored. We sought to determine if care in specific intensive care unit (ICU) rooms asymmetrically harbored CDI cases. Patients and Methods: Surgical intensive care unit (SICU) patients developing CDI (July 2009 to June 2018) were identified and separated by service (green/gold). Each service cared for their respective 12 rooms, otherwise differing only in resident team composition (July 2009 to August 2017: green, anesthesia; gold, surgery; August 2017 to June 2018: mixed for both). Fixed/mobile room features and provider traffic in three room zones (far/middle/near in relation to the toilet) were compared between high-/low-incidence rooms using observation via telecritical care video cameras. Results: Seventy-four new CDI cases occurred in 7,834 consecutive SICU admissions. In period one, green CDI cases were almost double gold cases (39 vs. 21; p = 0.02) but were similar in period two in which trainee service allocation intermixed. High-incidence rooms had closer toilet-to-intravenous pole proximity than low-incidence rooms (7.7 + 1.8 feet vs. 3.9 + 1.5 feet; p = 0.02). High-incidence rooms consistently housed mobile objects (patient bed, table-on-wheels) farther away from the toilet. Although physician time spent in each zone was similar, nurses spending more than 15 minutes in-room more frequently stayed in the far/middle zones in high-incidence rooms. Conclusions: Distinct SICU room features relative to toilet location and bedside clinician behaviors interact to alter patient CDI acquisition risk. This suggests that CDI risk occurs as a structural aspect of ICU care, offering the potential to reduce patient risk through deliberate room redesign.
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Affiliation(s)
- Sarah Danehower
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jared Lazorko
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lewis J Kaplan
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Fegley
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Juliane Jablonski
- Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Lily Owei
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew J Ziegler
- Division of Infectious Diseases, Department of Medicine, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Michael Pisa
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Pegues
- Division of Infectious Diseases, Department of Medicine, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Healthcare Epidemiology, Infection Prevention and Control, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jose L Pascual
- Department of Surgery, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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18
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Brought to Light: How Ultraviolet Disinfection Can Prevent the Nosocomial Transmission of COVID-19 and Other Infectious Diseases. Appl Microbiol 2021. [DOI: 10.3390/applmicrobiol1030035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic has brought to light the role of environmental hygiene in controlling disease transmission. Healthcare facilities are hot spots for infectious pathogens where physical distancing and personal protective equipment (PPE) are not always sufficient to prevent disease transmission. Healthcare facilities need to consider adjunct strategies to prevent transmission of infectious pathogens. In combination with current infection control procedures, many healthcare facilities are incorporating ultraviolet (UV) disinfection into their routines. This review considers how pathogens are transmitted in healthcare facilities, the mechanism of UV microbial inactivation and the documented activity of UV against clinical pathogens. Emphasis is placed on the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as well as multidrug resistant organisms (MDROs) that are commonly transmitted in healthcare facilities. The potential benefits and limitations of UV technologies are discussed to help inform healthcare workers, including clinical studies where UV technology is used in healthcare facilities.
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19
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Krishna A, Chopra T. Prevention of Infection due to Clostridium (Clostridioides) difficile. Infect Dis Clin North Am 2021; 35:995-1011. [PMID: 34752229 DOI: 10.1016/j.idc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Clostridium (Clostridioides) difficile infection (CDI) causes significant morbidity and mortality in the United States every year. Prevention of CDI is difficult because of spore durability and requires implementation of multipronged strategies. Two categories of prevention strategies are infection control and prevention and risk factor reduction. Hand hygiene, contact precautions, patient isolation, and environmental decontamination are cornerstones of infection control and prevention. Risk factor reduction should focus on antibiotic stewardship to reduce unnecessary antibiotic use. If CDI incidence remains higher than the institution's goal despite these measures, then special measures should be considered.
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Affiliation(s)
- Amar Krishna
- Internal Medicine, Norther Light AR Gould Hospital, 140 Academy Street, Presque Isle, ME 04769, USA.
| | - Teena Chopra
- Infectious Diseases, Wayne State University/Detroit Medical Center, UHC-2B, 4201 St Antoine, Detroit, MI 48201, USA
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20
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Mizusawa M, Carroll KC. The future of Clostridioides difficile diagnostics. Curr Opin Infect Dis 2021; 34:483-490. [PMID: 34524199 DOI: 10.1097/qco.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although the epidemiology of Clostridioides difficile has changed, this organism continues to cause significant morbidity and mortality. This review addresses current and future approaches to the diagnosis of C. difficile disease. RECENT FINDINGS Over the last several years, large prospective studies have confirmed that there is no single optimal test for the diagnosis of C. difficile disease. The pendulum has swung from a focus on rapid molecular diagnosis during the years of the ribotype 027 epidemic, to a call for use of algorithmic approaches that include a test for toxin detection. In addition, diagnostic stewardship has been shown to improve test utilization, especially with molecular methods. Advances in testing include development of ultrasensitive toxin tests and an expansion of biomarkers that may be more C. difficile specific. Microbiome research may be leveraged to inform novel diagnostic approaches based on measurements of volatile and nonvolatile organic compounds in stool. SUMMARY As rates of C. difficile infection decline, emphasis is now on improving test utilization and a quest for improved diagnostic approaches. These approaches may involve implementation of technologies that improve toxin testing, predict patients likely to have disease and/or a severe outcome, and harnessing research on changes in the microbiome to advance metabolomics.
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Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, Missouri
| | - Karen C Carroll
- Division of Medical Microbiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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Miller AC, Sewell DK, Segre AM, Pemmaraju SV, Polgreen PM. Risk for Clostridioides difficile Infection Among Hospitalized Patients Associated With Multiple Healthcare Exposures Prior to Admission. J Infect Dis 2021; 224:684-694. [PMID: 33340038 DOI: 10.1093/infdis/jiaa773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a common healthcare-associated infection and is often used as an indicator of hospital safety or quality. However, healthcare exposures occurring prior to hospitalization may increase risk for CDI. We conducted a case-control study comparing hospitalized patients with and without CDI to determine if healthcare exposures prior to hospitalization (ie, clinic visits, antibiotics, family members with CDI) were associated with increased risk for hospital-onset CDI, and how risk varied with time between exposure and hospitalization. METHODS Records were collected from a large insurance-claims database from 2001 to 2017 for hospitalized adult patients. Prior healthcare exposures were identified using inpatient, outpatient, emergency department, and prescription drug claims; results were compared between various CDI case definitions. RESULTS Hospitalized patients with CDI had significantly more frequent healthcare exposures prior to admission. Healthcare visits, antibiotic use, and family exposures were associated with greater likelihood of CDI during hospitalization. The degree of association diminished with time between exposure and hospitalization. Results were consistent across CDI case definitions. CONCLUSIONS Many different prior healthcare exposures appear to increase risk for CDI presenting during hospitalization. Moreover, patients with CDI typically have multiple exposures prior to admission, confounding the ability to attribute cases to a particular stay.
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Affiliation(s)
- Aaron C Miller
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Daniel K Sewell
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, Iowa, USA
| | - Sriram V Pemmaraju
- Department of Computer Science, University of Iowa, Iowa City, Iowa, USA
| | - Philip M Polgreen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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22
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Khanafer N, Vanhems P, Bennia S, Martin-Gaujard G, Juillard L, Rimmelé T, Argaud L, Martin O, Huriaux L, Marcotte G, Hernu R, Floccard B, Cassier P, Group S. Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147528. [PMID: 34299978 PMCID: PMC8307155 DOI: 10.3390/ijerph18147528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
Introduction: Clostridioides (Clostridium) difficile can be isolated from stool in 3% of healthy adults and in at least 10% of asymptomatic hospitalized patients. C. difficile, the most common cause of hospital-acquired infectious diarrhea in the developed world, has re-emerged in recent years with increasing incidence and severity. In an effort to reduce the spread of the pathogen, published recommendations suggest isolation and contact precautions for patients suffering from C. difficile infection (CDI). However, asymptomatic colonized patients are not targeted by infection control policies, and active surveillance for colonization is not routinely performed. Moreover, given the current changes in the epidemiology of CDI, particularly the emergence of new virulent strains either in the hospital or community settings, there is a need for identification of factors associated with colonization by C. difficile and CDI. Methods and analysis: We are carrying out a prospective, observational, cohort study in Edouard Herriot Hospital, Hospices Civils de Lyon, a 900-bed university hospital in Lyon, France. All consecutive adult patients admitted on selected units are eligible to participate in the study. Stool samples or rectal swabs for C. difficile testing are obtained on admission, every 3–5 days during hospitalization, at the onset of diarrhea (if applicable), and at discharge. Descriptive and logistic regression analyses will be completed to mainly estimate the proportion of asymptomatic colonization at admission, and to evaluate differences between factors associated with colonization and those related to CDI. Ethics: The study is conducted in accordance with the ethical principles of the Declaration of Helsinki, French law, and the Good Clinical Practice guidelines. The study protocol design was approved by the participating units, the ethics committee and the hospital institutional review board (Comité de protection des personnes et Comission Nationale de l’Informatique et des Libertés; N°: 00009118). Dissemination: The results of this study will be disseminated by presenting the findings locally at each participating ward, as well as national and international scientific meetings. Findings will be shared with interested national societies crafting guidelines in CDI.
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Affiliation(s)
- Nagham Khanafer
- International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon 1 University, 69342 Lyon, France;
- Department of Hygiene, Epidemiology, and Prevention, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France;
- European Study Group for Clostridioides Difficile (ESGCD), 4001 Basel, Switzerland
- Correspondence:
| | - Philippe Vanhems
- International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon 1 University, 69342 Lyon, France;
- Department of Hygiene, Epidemiology, and Prevention, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France;
- INSERM, F-CRIN, Réseau Innovative Clinical Research in Vaccinology (I-REIVAC), 75679 Paris, France
| | - Sabrina Bennia
- Department of Hygiene, Epidemiology, and Prevention, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France;
| | | | - Laurent Juillard
- Nephrology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France;
| | - Thomas Rimmelé
- Anesthesia and Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (T.R.); (O.M.); (L.H.); (G.M.); (B.F.)
- EA 7426 PI3 (Pathophysiology of Injury-Induced Immunosuppression), Lyon 1 University, Hospices Civils de Lyon, Biomérieux, 69437 Lyon, France
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (L.A.); (R.H.)
| | - Olivier Martin
- Anesthesia and Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (T.R.); (O.M.); (L.H.); (G.M.); (B.F.)
| | - Laetitia Huriaux
- Anesthesia and Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (T.R.); (O.M.); (L.H.); (G.M.); (B.F.)
| | - Guillaume Marcotte
- Anesthesia and Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (T.R.); (O.M.); (L.H.); (G.M.); (B.F.)
| | - Romain Hernu
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (L.A.); (R.H.)
| | - Bernard Floccard
- Anesthesia and Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France; (T.R.); (O.M.); (L.H.); (G.M.); (B.F.)
| | - Pierre Cassier
- Environnemental Laboratory, Institut des Agents Infectieux, Hospices Civils de Lyon, 69317 Lyon, France;
| | - Study Group
- Edouard Herriot Hospital, Hospices Civils de Lyon, 69437 Lyon, France;
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23
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D'Agata EMC, Apata IW, Booth S, Boyce JM, Deaver K, Gualandi N, Neu A, Nguyen D, Novosad S, Palevsky PM, Rodgers D. Suggestions for the prevention of Clostridioides difficile spread within outpatient hemodialysis facilities. Kidney Int 2021; 99:1045-1053. [PMID: 33667504 PMCID: PMC10506371 DOI: 10.1016/j.kint.2021.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 11/26/2022]
Abstract
Clostridioides difficile infections (CDIs) cause substantial morbidity and mortality. Patients on maintenance hemodialysis are 2 to 2.5 times more likely to develop CDI, with mortality rates 2-fold higher than the general population. Hospitalizations due to CDI among the maintenance hemodialysis population are high, and the frequency of antibiotic exposures and hospitalizations may contribute to CDI risk. In this report, a panel of experts in clinical nephrology, infectious diseases, and infection prevention provide guidance, based on expert opinion and published literature, aimed at preventing the spread of CDI in outpatient hemodialysis facilities.
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Affiliation(s)
- Erika M C D'Agata
- Division of Infectious Diseases, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Ibironke W Apata
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephanie Booth
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, Connecticut, USA
| | - Karen Deaver
- University of Virginia Dialysis Program, Charlottesville, Virginia, USA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia Neu
- Division of Pediatric Nephrology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Duc Nguyen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Novosad
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul M Palevsky
- Renal Section, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA; Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Darlene Rodgers
- American Society of Nephrology Alliance for Kidney Health, Washington, DC, USA
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24
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Mizusawa M, Carroll KC. Advances and required improvements in methods to diagnosing Clostridioides difficile infections in the healthcare setting. Expert Rev Mol Diagn 2021; 21:311-321. [PMID: 33682564 DOI: 10.1080/14737159.2021.1900737] [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] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Clostrididioides difficile is associated with adverse clinical outcomes and increased morbidity, mortality, length of hospital stay, and health-care costs.Areas Covered: We searched relevant papers in PubMed for the last 10 years. In major papers, we scanned the bibliographies to ensure that important articles were included. This review addresses the evolving epidemiology of Clostridioides difficile infection (CDI) and discusses novel methods/approaches for improving the diagnosis of this important disease. EXPERT OPINION No single diagnostic test to date has demonstrated optimum sensitivity and specificity for detection of CDI. Many institutions have developed multi-step algorithms consistent with guidelines established by various professional societies. Some institutions have successfully tried to improve the pretest probability of molecular assays by implementing appropriate sample rejection criteria and establishing best practice alerts at the time of electronic order entry. Others have established PCR cycle threshold cutoffs to attempt to differentiate symptomatic patients from asymptomatic carriers or to make predictions about severity of disease with variable success. As research advances our understanding of C. difficile pathogenesis and pathophysiology, more information on CDI specific biomarkers is emerging. Finally, assessments of the microbiome and metabolome may expand the diagnostic armamentarium with advances in mass spectrometry and sequencing technologies.
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Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, Missouri, Kansas City, MO, USA
| | - Karen C Carroll
- Director Division of Medical Microbiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Qiao Y, Qiu Z, Tian F, Yu L, Zhao J, Zhang H, Zhai Q, Chen W. Pediococcus acidilactici Strains Improve Constipation Symptoms and Regulate Intestinal Flora in Mice. Front Cell Infect Microbiol 2021; 11:655258. [PMID: 33816357 PMCID: PMC8012752 DOI: 10.3389/fcimb.2021.655258] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
Constipation is a prevalent gastrointestinal disorder that seriously reduces the quality of life. Clinical studies have shown that a great change or severe imbalance occurs in the intestinal microbiota of people with constipation. This study explored whether bacteriocin-producing and non-bacteriocin-producing Pediococcus acidilactici strains resulted in differences in the alleviation of constipation and changes in the fecal flora in BALB/c mice. The constipation-related indicators, gastrointestinal regulatory peptides and gut microbiota were identified to evaluate their alleviating effects and underlying mechanisms. The time to the first black-stool defecation and the gastrointestinal transit rate in constipated mice were found to be somewhat improved by four P. acidilactici strains (P > 0.05). Moreover, there were significant differences in the level of most gastrointestinal regulatory peptides in the serum, as well as in the composition and abundance of intestinal microbiota in different groups (P < 0.05). At the phylum level, the relative abundance of Firmicutes was significantly increased, but those of Bacteroidetes and Proteobacteria were significantly reduced after the administration of four P. acidilactici strains for 14 d (P < 0.05). The levels of Bacteroides and genera from Enterobacteriaceae were significantly decreased, whereas Bifidobacterium and Lactobacillus were upregulated when bacteriocin-producing P. acidilactici CCFM18 and CCFM28 strains were provided in the diet (P < 0.05). The results indicated that although constipation-related symptoms were alleviated to only a limited degree, the administration of four P. acidilactici strains effectively regulated the gut flora and provided a potential health benefit to the host, especially the bacteriocin-producing P. acidilactici strains.
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Affiliation(s)
- Yiteng Qiao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Zhichang Qiu
- College of Food Science and Engineering, Shandong Agricultural University, Tai'an, China
| | - Fengwei Tian
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Leilei Yu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Hao Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China.,National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China.,Wuxi Translational Medicine Research Center, Jiangsu Translational Medicine, Research Institute Wuxi Branch, Wuxi, China
| | - Qixiao Zhai
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, China.,School of Food Science and Technology, Jiangnan University, Wuxi, China.,National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China
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Persistence of Pathogens on Inanimate Surfaces: A Narrative Review. Microorganisms 2021; 9:microorganisms9020343. [PMID: 33572303 PMCID: PMC7916105 DOI: 10.3390/microorganisms9020343] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
For the prevention of infectious diseases, knowledge about transmission routes is essential. In addition to respiratory, fecal-oral, and sexual transmission, the transfer of pathogens via surfaces plays a vital role for human pathogenic infections-especially nosocomial pathogens. Therefore, information about the survival of pathogens on surfaces can have direct implications on clinical measures, including hygiene guidelines and disinfection strategies. In this review, we reviewed the existing literature regarding viral, bacterial, and fungal persistence on inanimate surfaces. In particular, the current knowledge of the survival time and conditions of clinically relevant pathogens is summarized. While many pathogens persist only for hours, common nosocomial pathogens can survive for days to weeks under laboratory conditions and thereby potentially form a continuous source of transmission if no adequate inactivation procedures are performed.
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Dharmasena M, Wang H, Wei T, Bridges WC, Jiang X. Survival of Clostridioides difficile in finished dairy compost under controlled conditions. J Appl Microbiol 2021; 131:996-1006. [PMID: 33450103 DOI: 10.1111/jam.15001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
AIM The survival of Clostridioides difficile (previously Clostridium difficile) vegetative cells and endospores was compared at different levels of indigenous microflora using autoclaved and unautoclaved dairy composts with different moisture contents (MCs). METHODS AND RESULTS Both types of composts adjusted to 20, 30 and 40% MCs were inoculated with a suspension of C. difficile that contained both vegetative cells (c. 5-6 log CFU per gram) and endospores (c. 5·0 CFU per gram), and then stored aerobically inside a humidity-controlled chamber at room temperature 22·5 ± 0·8°C for 1 year. The level of indigenous microflora was very stable during the storage after day 7 in both types of compost. The greatest reductions of C. difficile vegetative cell counts occurred during the first 24 h of storage in autoclaved and unautoclaved composts, which had 4·7 and 5·5 log CFU per gram with 20% MC, 1·8 and 2·1 log CFU per gram with 30% MC, and 2·3 and 1·3 log CFU per gram with 40% MC, respectively. Both MC and the duration of storage have significant (P < 0·05) effects on the survival of vegetative cells for first 120 days of storage. The slow inactivation of C. difficile vegetative cells at higher MCs during aerobic storage was confirmed by exponentially decaying modelling data during the early stage of aerobic exposure. The reduction of endospore counts (<1·0 log CFU per gram) during the storage for both types of compost at all MCs was not significant (P > 0·05) except for the autoclaved compost with 30% MC. CONCLUSION The highly resistant C. difficile endospores to the unfavourable environmental conditions survived for more than a year while vegetative cells died off exponentially upon the initial aerobic exposure. SIGNIFICANCE AND IMPACT OF THE STUDY The long-term survival of C. difficile endospores in contaminated compost may transmit the pathogen to fresh produce, animals or water in pre-harvest conditions.
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Affiliation(s)
- M Dharmasena
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA
| | - H Wang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA
| | - T Wei
- Department of Mathematical Sciences, Clemson University, Clemson, SC, USA
| | - W C Bridges
- Department of Mathematical Sciences, Clemson University, Clemson, SC, USA
| | - X Jiang
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA
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Gupta A, Tennakoon L, Spain DA, Forrester JD. Outcomes after Surgery among Patients Diagnosed with One or More Multi-Drug-Resistant Organisms. Surg Infect (Larchmt) 2021; 22:722-729. [PMID: 33471591 DOI: 10.1089/sur.2020.400] [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] [Indexed: 01/18/2023] Open
Abstract
Background: Infections with multi-drug-resistant organisms (MDROs) may be difficult to treat and prolong patient hospitalization and recovery. Multiple MDRO coinfections may increase the complexity of clinical management. However, association between multiple MDROs and outcomes of patients who undergo surgery is unknown. Patients and Methods: We performed a retrospective, cross-sectional analysis of the 2016 National Inpatient Sample for identified by International Classification of Disease, 10th Revision Clinical Modification (ICD-10-CM) diagnosis codes associated with multi-drug-resistant organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), multi-drug-resistant gram-negative bacilli, and Clostridioides difficile infection (CDI). Admitted patients with diagnosis codes for MDROs were cross-matched with codes for common general surgery procedures. Outcomes of interest included length of stay and mortality. Weighted univariable and multivariable analyses accounting for the survey methodology were performed. Results: Of 1,550,224 patients undergoing surgery in 2016, 39,065 (3%) admissions were diagnosed with an MDRO and 1,176 (0.1%) were associated with dual MDROs diagnoses. Patients diagnosed with one MDRO were hospitalized three times longer (17.3 days; 95% confidence interval [CI], 16.8-17.7) and patients diagnosed with two MDROs five times longer (31.6 days; 95% CI, 27.0-36.2; p < 0.0001) than undiagnosed patients (6.1 days; 95% CI, 6.1-6.1; all p < 0.0001). On multivariable analysis, the strongest predictor of mortality was a diagnosis of two MDRO infections (odds ratio [OR], 4.8; 95% CI, 3.16-7.21; p < 0.0001). The second strongest predictor was diagnosis of single MDRO infection (OR, 2.9; 95% CI, 2.64-3.20; p < 0.0001). Conclusion: Presence of an MDRO was associated with increased odds of mortality and length of stay in admitted surgical patients. Interventions to reduce MDRO infection among surgical patients may reduce hospital length of stay and mortality.
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Affiliation(s)
- Anshal Gupta
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Lakshika Tennakoon
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - David A Spain
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
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Eyre DW, Laager M, Walker AS, Cooper BS, Wilson DJ, on behalf of the CDC Modeling Infectious Diseases in Healthcare Program (MInD-Healthcare). Probabilistic transmission models incorporating sequencing data for healthcare-associated Clostridioides difficile outperform heuristic rules and identify strain-specific differences in transmission. PLoS Comput Biol 2021; 17:e1008417. [PMID: 33444378 PMCID: PMC7840057 DOI: 10.1371/journal.pcbi.1008417] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/27/2021] [Accepted: 10/05/2020] [Indexed: 12/28/2022] Open
Abstract
Fitting stochastic transmission models to electronic patient data can offer detailed insights into the transmission of healthcare-associated infections and improve infection control. Pathogen whole-genome sequencing may improve the precision of model inferences, but computational constraints have limited modelling applications predominantly to small datasets and specific outbreaks, whereas large-scale sequencing studies have mostly relied on simple rules for identifying/excluding plausible transmission. We present a novel approach for integrating detailed epidemiological data on patient contact networks in hospitals with large-scale pathogen sequencing data. We apply our approach to study Clostridioides difficile transmission using a dataset of 1223 infections in Oxfordshire, UK, 2007-2011. 262 (21% [95% credibility interval 20-22%]) infections were estimated to have been acquired from another known case. There was heterogeneity by sequence type (ST) in the proportion of cases acquired from another case with the highest rates in ST1 (ribotype-027), ST42 (ribotype-106) and ST3 (ribotype-001). These same STs also had higher rates of transmission mediated via environmental contamination/spores persisting after patient discharge/recovery; for ST1 these persisted longer than for most other STs except ST3 and ST42. We also identified variation in transmission between hospitals, medical specialties and over time; by 2011 nearly all transmission from known cases had ceased in our hospitals. Our findings support previous work suggesting only a minority of C. difficile infections are acquired from known cases but highlight a greater role for environmental contamination than previously thought. Our approach is applicable to other healthcare-associated infections. Our findings have important implications for effective control of C. difficile.
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Affiliation(s)
- David W. Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, United Kingdom
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, United Kingdom
| | - Mirjam Laager
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - A. Sarah Walker
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, United Kingdom
| | - Ben S. Cooper
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Daniel J. Wilson
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, United Kingdom
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Byrns G, Barham B, Yang L, Webster K, Rutherford G, Steiner G, Petras D, Scannell M. Usos y limitaciones de la lámpara ultravioleta germicida portátil para la desinfección de superficies. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S75-S85. [PMID: 33822696 DOI: 10.1080/15459624.2021.1877057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENLa morbimortalidad causada por infecciones vinculadas a la atención sanatoria ha llevado a cuestionar si los métodos de desinfección convencionales son inadecuados y se requieren métodos complementarios, como la fumigación de la habitación y la irradiación ultravioleta. Ello ha dado lugar a la preocupación por que estos métodos alternativos puedan poner en riesgo al personal sanitario y a los pacientes.Objetivos. (1) Determinar la eficacia de la lámpara ultravioleta C germicida portátil para la desinfección de superficies, (2) evaluar el cambio de la humedad relativa (HR) y las distintas distancias específicas en las tasas de letalidad bacteriana, y (3) evaluar los posibles problemas a que conlleva la exposición.Métodos. En el presente estudio se investiga si una lámpara germicida portátil puede desinfectar de forma eficaz superficies tratadas con esporulación o germinación bacteriana y se evalúa el efecto de condiciones ambientales cambiantes, como la humedad relativa (HR), la posición y las distancias específicas, en las tasas de letalidad germicida.Resultados. Se constató una mejor tasa de letalidad con una HR de 40-65% y en un rango de temperatura de 21-24°C. Tanto la HR alta como la HR baja interfirieron con la capacidad de la radiación UV-C para inactivar la germinación microbiana. En el caso de la esporulación bacteriana, el aumento del secado de la superficie fue el factor de mayor importancia para aumentar la tasa de letalidad.Conclusiones. En esta investigación se demostró la eficacia de la radiación UV-C bajo condiciones óptimas, irradiación directa y una distancia específica corta (12.7 cm). Sin embargo, cuando es utilizada en condiciones que no son óptimas existen limitaciones. El aumento de la distancia y los ángulos de irradiación indirecta resultaron en tasas de letalidad más bajas. Cabe señalar que durante su uso es importante minimizar la exposición innecesaria de pacientes y personal sanitario.
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Affiliation(s)
- George Byrns
- Salud Ambiental, Universidad Estatal de Illinois, Normal, Illinois
| | - Beverly Barham
- Ciencia de Laboratorio Médico, Universidad Estatal de Illinois, Normal, Illinois
| | - Liangcheng Yang
- Salud Ambiental, Universidad Estatal de Illinois, Normal, Illinois
| | - Kathryn Webster
- Ciencia de Laboratorio Médico, Universidad Estatal de Illinois, Normal, Illinois
| | - George Rutherford
- Departamento de Física, Universidad Estatal de Illinois, Normal, Illinois
| | - Garrett Steiner
- Salud Ambiental, Universidad Estatal de Illinois, Normal, Illinois
| | - Daniel Petras
- Salud Ambiental, Universidad Estatal de Illinois, Normal, Illinois
| | - Michele Scannell
- Asesor de Control de Riesgos, The Cincinnati Insurance Companies, Chicago, Illinois
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Heise J, Witt P, Maneck C, Wichmann-Schauer H, Maurischat S. Prevalence and phylogenetic relationship of Clostridioides difficile strains in fresh poultry meat samples processed in different cutting plants. Int J Food Microbiol 2020; 339:109032. [PMID: 33388709 DOI: 10.1016/j.ijfoodmicro.2020.109032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/07/2023]
Abstract
Clostridioides difficile is one of the most frequent causes of nosocomial infections in humans leading to (antibiotic-associated) diarrhea and severe pseudomembranous colitis. With an increasing frequency, C. difficile infections (CDI) are also observed independently of hospitalization and the age of the patients in an ambulant setting. One potential source of so-called community-acquired CDI is a zoonotic transmission to humans based on direct contact with animals or the consumption of food. To estimate the exposure of humans with C. difficile via food, we screened 364 different retail fresh poultry meat products purchased in Berlin and Brandenburg, Germany and further characterized the isolates. None of the 42 turkey or chicken meat samples without skin was contaminated. However, 51 (15.8%) of 322 tested fresh chicken meat samples with skin were C. difficile-positive. The vast majority (84.3%) of all isolates exhibited toxin genes tcdA and tcdB, whereas the binary toxin cdtA/B was absent. Most of the isolates (50/51) were susceptible to all six investigated antimicrobials. However, one non-toxigenic strain was multidrug resistant to the antimicrobials clindamycin and erythromycin. The isolates were mainly represented by PCR-ribotypes (RT) 001, RT002, RT005, and RT014, which were already associated with human CDI cases in Germany and were partially detected in poultry. The relatively high contamination rate of fresh retail chicken meat with skin purchased in Germany indicates chicken meat as a potential source of human infections. Moreover, we identified cutting plants with a higher rate of a C. difficile-contamination (21.4-32.8%). To compare the phylogenetic relationship of the isolated strains from certain cutting plants over several months in 2018 and 2019, we analyzed them using NGS followed by core genome MLST. Interestingly, highly related strains (0-3 alleles distance) of common clinical RT001 and RT002 isolates, as well as of the non-toxigenic RT205 isolates were detectable in same cutting plants over a period of three and 16 months, respectively.The continuous contamination with the same strain could be explained by the longterm persistence of this strain within the cutting plant (e.g., within the scalder), or with a recurring entry e.g. from the same fattening farm.
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Affiliation(s)
- Janine Heise
- German Federal Institute for Risk Assessment, Department Biological Safety, Unit Bacterial Toxins, Food Service, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany.
| | - Pascal Witt
- German Federal Institute for Risk Assessment, Department Biological Safety, Unit Bacterial Toxins, Food Service, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Corinna Maneck
- German Federal Institute for Risk Assessment, Department Biological Safety, Unit Bacterial Toxins, Food Service, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Heidi Wichmann-Schauer
- German Federal Institute for Risk Assessment, Department Biological Safety, Unit Bacterial Toxins, Food Service, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Sven Maurischat
- German Federal Institute for Risk Assessment, Department Biological Safety, Unit Bacterial Toxins, Food Service, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
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Investigating the association of room features with healthcare-facility-onset Clostridioides difficile: An exploratory study. Infect Control Hosp Epidemiol 2020; 42:847-852. [PMID: 33261688 DOI: 10.1017/ice.2020.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate hospital room and patient-level risk factors associated with increased risk of healthcare-facility-onset Clostridioides difficile infection (HO-CDI). DESIGN The study used a retrospective cohort design that included patient data from the institution's electronic health record, existing surveillance data on HO-CDI, and a walk-through survey of hospital rooms to identify potential room-level risk factors. The primary outcome was HO-CDI diagnosis. SETTING A large academic medical center. PATIENTS AND PARTICIPANTS All adult patients admitted between January 1, 2015, and December 31, 2016 were eligible for inclusion. Prisoners were excluded. Patients who only stayed in rooms that were not surveyed were excluded. RESULTS The hospital room survey collected room-level data on 806 rooms. Included in the study were 17,034 patients without HO-CDI and 251 with HO-CDI nested within 535 unique rooms. In this exploratory study, room-level risk factors associated with the outcome in the multivariate model included wear on furniture and flooring and antibiotic use by the prior room occupant. Hand hygiene devices and fixed in-room computers were associated with reduced odds of a HO-CDI. Differences between hospital buildings were also detected. The only individual patient factors that were associated with increased odds of HO-CDI were antibiotic use and comorbidity score. CONCLUSION Combining a hospital-room walk-through data collection survey, EHR data, and CDI surveillance data, we were able to develop a model to investigate room and patient-level risks for HO-CDI.
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Cooper CW, Aithinne KAN, Stevenson BS, Black JE, Johnson DL. Comparison and evaluation of a high volume air sampling system for the collection of Clostridioides difficile endospore aerosol in health care environments. Am J Infect Control 2020; 48:1354-1360. [PMID: 32334002 DOI: 10.1016/j.ajic.2020.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Environmental contamination of patient rooms and adjacent areas with C. difficile spores is a recognized transmission risk. Previous studies have shown that spores are aerosolized during patient care. These spores can remain airborne for extended periods and may contaminate distant surfaces. High-volume air sampling equipment allows for the collection of a large volume of air and was evaluated in the collection of C. difficile aerosol. METHOD Air samplers evaluated in this research included the DFU-1000, XMX/2L-MIL, Biocapture-650, and a MB2. Aerosols of C. difficile were generated in a 5-m3 chamber and each air sampler sampled in the aerosol test chamber simultaneously with referee air samplers. RESULTS The DFU-1000 achieved the highest efficiency of the 4 air samplers (P = .0145) with a mean efficiency of 38.60%. The relative efficiencies of the Biocapture-650, XMX/2L-MIL, and MB2 were 28.16%, 10.51%, and 3.05%, respectively. DISCUSSION/CONCLUSIONS This study demonstrated high variation based on the sampling method employed. Based on the results of these studies, high-volume air samplers may be effectively applied to sample for airborne C. difficile in health care environments. The high sampling flow rate of the DFU-1000 would allow for the complete sampling of a patient room-sized volume in less than 1 hour.
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Affiliation(s)
- Casey W Cooper
- Department of Systems and Engineering Management, Air Force Institute of Technology, Wright-Patterson AFB, OH.
| | - Kathleen A N Aithinne
- Department of Occupational and Environmental Health, University of Oklahoma, Hudson College of Public Health, Oklahoma City, OK
| | - Bradley S Stevenson
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, OK
| | - Jon E Black
- Bioenvironmental Engineering, Wright Patterson Medical Center, Wright Patterson AFB, OH
| | - David L Johnson
- Department of Occupational and Environmental Health, University of Oklahoma, Hudson College of Public Health, Oklahoma City, OK
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Cassidy SS, Sanders DJ, Wade J, Parkin IP, Carmalt CJ, Smith AM, Allan E. Antimicrobial surfaces: A need for stewardship? PLoS Pathog 2020; 16:e1008880. [PMID: 33057433 PMCID: PMC7561179 DOI: 10.1371/journal.ppat.1008880] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sam S. Cassidy
- Materials Chemistry Research Centre, Department of Chemistry, University College London, London, United Kingdom
| | - David J. Sanders
- Department of Microbial Diseases, UCL Eastman Dental Institute, Royal Free Campus, University College London, London, United Kingdom
| | - Jim Wade
- Infection Sciences, King’s College Hospital, London, United Kingdom
| | - Ivan P. Parkin
- Materials Chemistry Research Centre, Department of Chemistry, University College London, London, United Kingdom
| | - Claire J. Carmalt
- Materials Chemistry Research Centre, Department of Chemistry, University College London, London, United Kingdom
| | - Andrew M. Smith
- Department of Microbial Diseases, UCL Eastman Dental Institute, Royal Free Campus, University College London, London, United Kingdom
| | - Elaine Allan
- Department of Microbial Diseases, UCL Eastman Dental Institute, Royal Free Campus, University College London, London, United Kingdom
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Odoyo E, Kyanya C, Mutai W, Musila L. High levels of toxigenic Clostridioides difficile contamination of hospital environments: a hidden threat in hospital-acquired infections in Kenya. Access Microbiol 2020; 2:acmi000171. [PMID: 33490867 PMCID: PMC7818243 DOI: 10.1099/acmi.0.000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction The contribution of Clostridioides difficile (formerly Clostridium difficile) to the burden of hospital-associated infections (HAIs) remains undetermined in many African countries. Aim This study aimed to identify a sensitive and readily adaptable C. difficile detection assay and to evaluate the C. difficile HAI risk in Kenya. Methodology Sterile swabs in neutralizing buffer were used to sample equipment or surfaces that patients and clinical staff touched frequently. These swabs were either plated directly on chromogenic agar or cultured in an enrichment broth before plating. The swab suspensions, enrichment broth and plate cultures were screened by quantitative PCR (qPCR) to determine the most efficient detection method. The HAI risk was evaluated by testing the C. difficile-positive samples by qPCR for the A, B and binary toxins. Results C. difficile was detected on 4/57 (7.0 %) equipment and surfaces by direct culture. The additional enrichment step increased the detection rate 10-fold to 43/57 (75.4 %). In total, 51/57 (89.5 %) environmental samples were positive for C. difficile detected through either culture or qPCR. The genes encoding the primary toxins, tcdA and tcdB, were detected on six surfaces, while the genes encoding the binary toxins, cdtA and cdtB, were detected on 2/57 (3.5 %) and 3/57 (5.3 %) surfaces, respectively. Different C. difficile toxin gene profiles were detected: the tcdA+/tcdB− gene profile on 4/10 (40 %) high-touch surfaces, tcdA−/tcdB+ on 3/10 (30 %) surfaces, tcdA+/tcdB+/cdtA+/cdtB+ on 2/10 (20 %) surfaces and tcdA−/tcdB+/cdtB+ on one high-touch surface. Conclusion The widespread contamination of hospital environments by toxigenic C. difficile gives a strong indication of the high risk of C. difficile infections (CDIs). The two-step culture process described can easily be adapted for monitoring hospital environment contamination by C. difficile.
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Affiliation(s)
- Erick Odoyo
- United States Army Medical Research Directorate - Africa, PO Box 606-00621, Nairobi, Kenya
| | - Cecilia Kyanya
- United States Army Medical Research Directorate - Africa, PO Box 606-00621, Nairobi, Kenya
| | - Winnie Mutai
- University of Nairobi, PO Box 30197-00200, Nairobi, Kenya
| | - Lillian Musila
- United States Army Medical Research Directorate - Africa, PO Box 606-00621, Nairobi, Kenya
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Maillard JY, Bloomfield SF, Courvalin P, Essack SY, Gandra S, Gerba CP, Rubino JR, Scott EA. Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings: A position paper. Am J Infect Control 2020; 48:1090-1099. [PMID: 32311380 PMCID: PMC7165117 DOI: 10.1016/j.ajic.2020.04.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of health care facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in health care settings requires a mirrored reduction in the community. The authors call upon national and international policy makers, health agencies, and health care professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.
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Affiliation(s)
- Jean-Yves Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK; International Scientific Forum on Home Hygiene, Somerset, UK.
| | | | | | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles P Gerba
- Departments of Soil, Water and Environmental Science and Environmental Health, University of Arizona, Tucson, AZ, USA
| | - Joseph R Rubino
- Research & Development, Home Hygiene, Lysol/Harpic, Reckitt Benckiser LLC., One Philips Parkway, Montvale, NJ, USA
| | - Elizabeth A Scott
- College of Natural, Behavioral and Health Sciences, Simmons University, Boston, MA, USA
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Toth DJA, Keegan LT, Samore MH, Khader K, O'Hagan JJ, Yu H, Quintana A, Swerdlow DL. Modeling the potential impact of administering vaccines against Clostridioides difficile infection to individuals in healthcare facilities. Vaccine 2020; 38:5927-5932. [PMID: 32703744 DOI: 10.1016/j.vaccine.2020.06.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND A vaccine against Clostridioides difficile infection (CDI) is in development. While the vaccine has potential to both directly protect those vaccinated and mitigate transmission by reducing environmental contamination, the impact of the vaccine on C. difficile colonization remains unclear. Consequently, the transmission-reduction effect of the vaccine depends on the contribution of symptomatic CDI to overall transmission of C. difficile. METHODS We designed a simulation model of CDI among patients in a network of 10 hospitals and nursing homes and calibrated the model using estimates of transmissibility from whole genome sequencing studies that estimated the fraction of CDI attributable to transmission from other CDI patients. We assumed the vaccine reduced the rate of progression to CDI among carriers by 25-95% after completion of a 3-dose vaccine course administered to randomly chosen patients at facility discharge. We simulated the administration of this vaccination campaign and tallied effects over 5 years. RESULTS We estimated 30 times higher infectivity of CDI patients compared to other carriers. Simulations of the vaccination campaign produced an average reduction of 3-16 CDI cases per 1000 vaccinated patients, with 2-11 of those cases prevented among those vaccinated and 1-5 prevented among unvaccinated patients. CONCLUSIONS Our findings demonstrate potential for a vaccine against CDI to reduce transmissions in healthcare facilities, even with no direct effect on carriage susceptibility. The vaccine's population impact will increase if received by individuals at risk for CDI onset in high-transmission settings.
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Affiliation(s)
- Damon J A Toth
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA.
| | - Lindsay T Keegan
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA
| | - Matthew H Samore
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA.
| | - Karim Khader
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine (Epidemiology), University of Utah, Salt Lake City, UT, USA
| | - Justin J O'Hagan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Clostridioides difficile Enteritis Induced Anastomotic Rupture: A Case Report and Literature Review. Case Rep Surg 2020; 2020:9794823. [PMID: 32607274 PMCID: PMC7313094 DOI: 10.1155/2020/9794823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/23/2020] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background. A 76-year-old male patient who suffered small bowel anastomotic dehiscence believed to be a complication provoked by Clostridioides difficile enteritis. Case Presentation. The patient was a 76-year-old male who underwent small bowel resection with primary anastomosis for a small bowel obstruction. On postoperative day #7, he rapidly decompensated and upon return to the operating room was found to have complete anastomotic dehiscence with copious enteric spillage. The presentation appeared as if the staple line had burst open. Enteric contents confirmed the diagnosis of Clostridioides difficile enteritis. Subsequent hospital course was complicated by ventilatory-dependent respiratory failure, hemodynamic instability, and persistent anemia secondary to gastric ulcer requiring endoscopic cauterization. After a prolonged hospital course, he eventually progressed and was transferred to a skilled nursing facility on hospital day #42. Discussion. Clostridioides difficile causes inflammation and copious large volume secretions that would theoretically increase intraluminal pressures creating an internal tension. This tension along with other factors from the infection itself would likely be inhibitory of anastomotic healing. Although it is rare, Clostridioides difficile enteritis is being reported with increasing frequency, and in the setting of recent small bowel anastomosis, it should be considered a possible risk factor for anastomotic leak.
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Mayer J, Stone ND, Leecaster M, Hu N, Pettey W, Samore M, Pacheco SM, Sambol S, Donskey C, Jencson A, Gupta K, Strymish J, Johnson D, Woods C, Young E, McDonald LC, Gerding D. Reinforcement of an infection control bundle targeting prevention practices for Clostridioides difficile in Veterans Health Administration nursing homes. Am J Infect Control 2020; 48:626-632. [PMID: 31812271 DOI: 10.1016/j.ajic.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) causes significant morbidity in nursing home residents. Our aim was to describe adherence to a bundled CDI prevention initiative, which had previously been deployed nationwide in Veterans Health Administration (VA) long-term care facilities (LTCFs), and to improve compliance with reinforcement. METHODS A multicenter pre- and post-reinforcement of the VA bundle consisting of environmental management, hand hygiene, and contact precautions was conducted in 6 VA LTCFs. A campaign to reinforce VA bundle components, as well as to promote select antimicrobial stewardship recommendations and contact precautions for 30 days, was employed. Hand hygiene, antimicrobial usage, and environmental contamination, before and after bundle reinforcement, were assessed. RESULTS All LTCFs reported following the guidelines for cleaning and contact precautions until diarrhea resolution pre-reinforcement. Environmental specimens rarely yielded C difficile pre- or post-reinforcement. Proper hand hygiene across all facilities did not change with reinforcement (pre 52.51%, post 52.18%), nor did antimicrobial use (pre 87-197 vs. post 84-245 antibiotic days per 1,000 resident-days). LTCFs found it challenging to maintain prolonged contact precautions. DISCUSSION Variation in infection prevention and antimicrobial prescribing practices across LTCFs were identified and lessons learned. CONCLUSIONS Introducing bundled interventions in LTCFs is challenging, given the available resources, and may be more successful with fewer components and more intensive execution with feedback.
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Miller AC, Segre AM, Pemmeraju SV, Sewell DK, Polgreen PM. Association of Household Exposure to Primary Clostridioides difficile Infection With Secondary Infection in Family Members. JAMA Netw Open 2020; 3:e208925. [PMID: 32589232 PMCID: PMC7320299 DOI: 10.1001/jamanetworkopen.2020.8925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022] Open
Abstract
Importance Clostridioides difficile infection (CDI) is a common hospital-acquired infection. Whether family members are more likely to experience a CDI following CDI in another separate family member remains to be studied. Objective To determine the incidence of potential family transmission of CDI. Design, Setting, and Participants In this case-control study comparing the incidence of CDI among individuals with prior exposure to a family member with CDI to those without prior family exposure, individuals were binned into monthly enrollment strata based on exposure status (eg, family exposure) and confounding factors (eg, age, prior antibiotic use). Data were derived from population-based, longitudinal commercial insurance claims from the Truven Marketscan Commercial Claims and Encounters and Medicare Supplemental databases from 2001 to 2017. Households with at least 2 family members continuously enrolled for at least 1 month were eligible. CDI incidence was computed within each stratum. A regression model was used to compare incidence of CDI while controlling for possible confounding characteristics. Exposures Index CDI cases were identified using inpatient and outpatient diagnosis codes. Exposure risks 60 days prior to infection included CDI diagnosed in another family member, prior hospitalization, and antibiotic use. Main Outcomes and Measures The primary outcome was the incidence of CDI in a given monthly enrollment stratum. Separate analyses were considered for CDI diagnosed in outpatient or hospital settings. Results A total of 224 818 cases of CDI, representing 194 424 enrollees (55.9% female; mean [SD] age, 52.8 [22.2] years) occurred in families with at least 2 enrollees. Of these, 1074 CDI events (4.8%) occurred following CDI diagnosis in a separate family member. Prior family exposure was significantly associated with increased incidence of CDI, with an incidence rate ratio (IRR) of 12.47 (95% CI, 8.86-16.97); this prior family exposure represented the factor with the second highest IRR behind hospital exposure (IRR, 16.18 [95% CI, 15.31-17.10]). For community-onset CDI cases without prior hospitalization, the IRR for family exposure was 21.74 (95% CI, 15.12-30.01). Age (IRR, 9.90 [95% CI, 8.92-10.98] for ages ≥65 years compared with ages 0-17 years), antibiotic use (IRR, 3.73 [95% CI, 3.41-4.08] for low-risk and 14.26 [95% CI, 13.27-15.31] for high-risk antibiotics compared with no antibiotics), and female sex (IRR, 1.44 [95% CI, 1.36-1.53]) were also positively associated with incidence. Conclusions and Relevance This study found that individuals with family exposure may be at significantly greater risk for acquiring CDI, which highlights the importance of the shared environment in the transmission and acquisition of C difficile.
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Affiliation(s)
| | | | | | | | - Philip M. Polgreen
- Department of Epidemiology, University of Iowa, Iowa City
- Department of Internal Medicine, University of Iowa, Iowa City
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Role of Clostridioides difficile in hospital environment and healthcare workers. Anaerobe 2020; 63:102204. [PMID: 32335312 DOI: 10.1016/j.anaerobe.2020.102204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 03/08/2020] [Accepted: 04/16/2020] [Indexed: 01/05/2023]
Abstract
Clostridioides difficile infection (CDI) was traditionally considered to be transmitted within healthcare environment, from other patients or healthcare workers (HCW). Recently, this idea has been challenged. Our objective was to determine the extent of C. difficile contamination in hospital environment with a simplified method for C. difficile recovery. Environmental samples were taken from rooms of patients positive for CDI (Case) and negative for toxigenic C. difficile (Control). Environmental sampling was performed at the time a fecal sample was taken for CDI diagnosis, 48 h after, and 10 days after. HCW hands were also sampled. A total of 476 environmental samples were collected, 246 samples from "Case" rooms and 230 from "Control". Overall, 15.34% of environmental samples were positive for toxigenic C. difficile (TCD), 20.72% of "Case" rooms samples and 9.57% of the samples from "Control" rooms (p = 0.001). When samples from "Case" rooms were analyzed by sampling time, at diagnosis 52.94% were positive, 38.46% were positive at 48 h after symptom resolution and 23.07% were positive after course of treatment. Overall, the most contaminated site corresponded to the bathroom tap, followed by the toilet. We recovered TCD from alcohol-based dispensers and from 4.2% of HCW hands. We found a high proportion of surfaces contaminated with TCD, as well as hand colonization. Notably, even after isolation measures were terminated, there was still TCD contamination.
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Bouza E, Aguado JM, Alcalá L, Almirante B, Alonso-Fernández P, Borges M, Cobo J, Guardiola J, Horcajada JP, Maseda E, Mensa J, Merchante N, Muñoz P, Pérez Sáenz JL, Pujol M, Reigadas E, Salavert M, Barberán J. Recommendations for the diagnosis and treatment of Clostridioides difficile infection: An official clinical practice guideline of the Spanish Society of Chemotherapy (SEQ), Spanish Society of Internal Medicine (SEMI) and the working group of Postoperative Infection of the Spanish Society of Anesthesia and Reanimation (SEDAR). REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:151-175. [PMID: 32080996 PMCID: PMC7111242 DOI: 10.37201/req/2065.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/26/2020] [Indexed: 12/12/2022]
Abstract
This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.
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Affiliation(s)
- E Bouza
- Emilio Bouza MD, PhD, Instituto de Investigación Sanitaria Gregorio Marañón, Servicio de Microbiología Clínica y E. Infecciosas C/ Dr. Esquerdo, 46 - 28007 Madrid, Spain.
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Prospective Evaluation of the mariPOC Test for Detection of Clostridioides difficile Glutamate Dehydrogenase and Toxins A/B. J Clin Microbiol 2020; 58:JCM.01872-19. [PMID: 31941691 DOI: 10.1128/jcm.01872-19] [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: 11/12/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to evaluate a novel automated random-access test, mariPOC CDI (ArcDia Ltd., Finland), for the detection of Clostridioides difficile glutamate dehydrogenase (GDH) and toxins A and B directly from fecal specimens. The mariPOC test was compared with both the GenomEra C. difficile PCR assay (Abacus Diagnostica Oy, Finland) and the TechLab C. diff Quik Chek Complete (Alere Inc.; now Abbot) membrane enzyme immunoassay (MEIA). Culture and the Xpert C. difficile assay (Cepheid Inc., USA) were used to resolve discrepant results. In total, 337 specimens were tested with the mariPOC CDI test and GenomEra PCR. Of these specimens, 157 were also tested with the TechLab MEIA. The sensitivity of the mariPOC test for GDH was slightly lower (95.2%) than that obtained with the TechLab assay (100.0%), but no toxin-positive cases were missed. The sensitivity of the mariPOC test for the detection of toxigenic C. difficile by analyzing toxin expression was better (81.6%) than that of the TechLab assay (71.1%). The analytical specificities for the mariPOC and the TechLab tests were 98.3% and 100.0% for GDH and 100.0% and 99.2% for toxin A/B, respectively. The analytical specificity of the GenomEra method was 100.0%. The mariPOC and TechLab GDH tests and GenomEra PCR had high negative predictive values of 99.3%, 98.3%, and 99.7%, respectively, in excluding infection with toxigenic C. difficile The mariPOC toxin A/B test and GenomEra PCR had an identical analytical positive predictive value of 100%, providing highly reliable information about toxin expression and the presence of toxin genes, respectively.
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Chen LH, Li Y, Qi Y, Wang SN, Gao CQ, Wu Y. Evaluation of a pulsed xenon ultraviolet light device for reduction of pathogens with biofilm-forming ability and impact on environmental bioburden in clinical laboratories. Photodiagnosis Photodyn Ther 2020; 29:101544. [DOI: 10.1016/j.pdpdt.2019.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/28/2023]
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Spatiotemporal clustering of in-hospital Clostridioides difficile infection. Infect Control Hosp Epidemiol 2020; 41:418-424. [PMID: 32000873 DOI: 10.1017/ice.2019.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine whether Clostridioides difficile infection (CDI) exhibits spatiotemporal interaction and clustering. DESIGN Retrospective observational study. SETTING The University of Iowa Hospitals and Clinics. PATIENTS This study included 1,963 CDI cases, January 2005 through December 2011. METHODS We extracted location and time information for each case and ran the Knox, Mantel, and mean and maximum component size tests for time thresholds (T = 7, 14, and 21 days) and distance thresholds (D = 2, 3, 4, and 5 units; 1 unit = 5-6 m). All tests were implemented using Monte Carlo simulations, and random CDI cases were constructed by randomly permuting times of CDI cases 20,000 times. As a counterfactual, we repeated all tests on 790 aspiration pneumonia cases because aspiration pneumonia is a complication without environmental factors. RESULTS Results from the Knox test and mean component size test rejected the null hypothesis of no spatiotemporal interaction (P < .0001), for all values of T and D. Results from the Mantel test also rejected the hypothesis of no spatiotemporal interaction (P < .0003). The same tests showed no such effects for aspiration pneumonia. Our results from the maximum component size tests showed similar trends, but they were not consistently significant, possibly because CDI outbreaks attributable to the environment were relatively small. CONCLUSION Our results clearly show spatiotemporal interaction and clustering among CDI cases and none whatsoever for aspiration pneumonia cases. These results strongly suggest that environmental factors play a role in the onset of some CDI cases. However, our results are not inconsistent with the possibility that many genetically unrelated CDI cases occurred during the study period.
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Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection. Infect Control Hosp Epidemiol 2020; 41:517-521. [PMID: 32000872 DOI: 10.1017/ice.2020.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is the most frequently reported hospital-acquired infection in the United States. Bioaerosols generated during toilet flushing are a possible mechanism for the spread of this pathogen in clinical settings. OBJECTIVE To measure the bioaerosol concentration from toilets of patients with CDI before and after flushing. DESIGN In this pilot study, bioaerosols were collected 0.15 m, 0.5 m, and 1.0 m from the rims of the toilets in the bathrooms of hospitalized patients with CDI. Inhibitory, selective media were used to detect C. difficile and other facultative anaerobes. Room air was collected continuously for 20 minutes with a bioaerosol sampler before and after toilet flushing. Wilcoxon rank-sum tests were used to assess the difference in bioaerosol production before and after flushing. SETTING Rooms of patients with CDI at University of Iowa Hospitals and Clinics. RESULTS Bacteria were positively cultured from 8 of 24 rooms (33%). In total, 72 preflush and 72 postflush samples were collected; 9 of the preflush samples (13%) and 19 of the postflush samples (26%) were culture positive for healthcare-associated bacteria. The predominant species cultured were Enterococcus faecalis, E. faecium, and C. difficile. Compared to the preflush samples, the postflush samples showed significant increases in the concentrations of the 2 large particle-size categories: 5.0 µm (P = .0095) and 10.0 µm (P = .0082). CONCLUSIONS Bioaerosols produced by toilet flushing potentially contribute to hospital environmental contamination. Prevention measures (eg, toilet lids) should be evaluated as interventions to prevent toilet-associated environmental contamination in clinical settings.
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Comparative Study of Clostridium difficile Clinical Detection Methods in Patients with Diarrhoea. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:8753284. [PMID: 32064010 PMCID: PMC6996696 DOI: 10.1155/2020/8753284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/30/2019] [Indexed: 12/16/2022]
Abstract
Objectives The aim of this study was to evaluate the clinical application of three methods for detecting Clostridium difficile in fecal samples. Methods One hundred and fifty fecal specimens were collected and tested for C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. Results Of 150 specimens, 26 carried both A and B toxin genes, and none of the samples were positive for the binary toxin gene. Toxin-producing C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. Conclusion The VIDAS GDH assay is useful for initial screening of C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay.
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Gilboa M, Houri-Levi E, Cohen C, Tal I, Rubin C, Feld-Simon O, Brom A, Eden-Friedman Y, Segal S, Rahav G, Regev-Yochay G. Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study. Clin Microbiol Infect 2020; 26:1052-1057. [PMID: 31904567 DOI: 10.1016/j.cmi.2019.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting. METHODS C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination. RESULTS One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5-99.96 p 0.0195, and 1.19-104.49 p 0.035), respectively. DISCUSSION Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.
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Affiliation(s)
- M Gilboa
- Internal Medicine D, Sheba Medical Centre, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel.
| | - E Houri-Levi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - C Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - I Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - C Rubin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Biostatistics Unit, Gertner Institute, Ramat Gan, Israel
| | - O Feld-Simon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel; Internal Medicine F, Sheba Medical Centre, Ramat Gan, Israel
| | - A Brom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel; Internal Medicine T, Sheba Medical Centre, Ramat Gan, Israel
| | - Y Eden-Friedman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Medicine E, Sheba Medical Centre, Ramat Gan, Israel
| | - S Segal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - G Rahav
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - G Regev-Yochay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Sheba Medical Centre, Ramat Gan, Israel; Infection Control & Prevention Unit, Sheba Medical Centre, Ramat Gan, Israel
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Abstract
How to cite this article: Bhattacharyya M, Debnath AK, Todi SK. Clostridium difficile and Antibiotic-associated Diarrhea. Indian J Crit Care Med 2020;24(Suppl 4):S162-S167.
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Affiliation(s)
- Mahuya Bhattacharyya
- Department of Critical Care Medicine, AMRI Hospitals, Kolkata, West Bengal, India
| | | | - Subhash K Todi
- Department of Critical Care Medicine, AMRI Hospitals, Kolkata, West Bengal, India
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Approaches to the detection of Clostridioides difficile in the healthcare environment. J Hosp Infect 2019; 103:375-381. [DOI: 10.1016/j.jhin.2019.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023]
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