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Clostridioides difficile in the environment, food, animals and humans in southern Italy: Occurrence and genetic relatedness. Comp Immunol Microbiol Infect Dis 2018; 59:41-46. [PMID: 30290886 DOI: 10.1016/j.cimid.2018.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 05/09/2018] [Accepted: 08/29/2018] [Indexed: 12/19/2022]
Abstract
One hundred and thirty-eight C. difficile isolates from different sources (66 from the environment, 36 from animals, 9 from food and 27 from humans) were ribotyped by capillary electrophoresis PCR ribotyping (CE-PCR). A multilocus variable tandem repeat analysis (MLVA) was carried out on a sample subset. The most frequently isolated PCR ribotypes were 126 (15.9%), 078 (14.5%), 011/018 (11.6%), 014/020/077 (10.1%), and 010 (2.8%). In particular, strains of PCR ribotype 011/018 were isolated from human, raw milk and environmental samples. The hypervirulent PCR ribotype 027 was isolated from two human samples. The majority of the strains were toxigenic (34.1% showed the toxigenic profile A+B+CDT+ and 38.9% the profile A+B+CDT-). MLVA allowed to identify 4 clonal complexes of genetically related isolates: complex n. 1 grouped together human, environmental and food strains, whereas complex n. 3 included human and environmental isolates. The use of MLVA gave further evidence to the possible role of environment, animals and food as routes of transmission of C. difficile infections to human.
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Hypervirulent Clostridium difficile Strain Has Arrived in Brazil. Infect Control Hosp Epidemiol 2018; 39:371-373. [DOI: 10.1017/ice.2017.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Popovic N, Korac M, Nesic Z, Milosevic B, Urosevic A, Jevtovic D, Mitrovic N, Markovic A, Jordovic J, Katanic N, Barac A, Milosevic I. Oral teicoplanin versus oral vancomycin for the treatment of severe Clostridium difficile infection: a prospective observational study. Eur J Clin Microbiol Infect Dis 2018; 37:745-754. [DOI: 10.1007/s10096-017-3169-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/17/2017] [Indexed: 12/12/2022]
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Nosocomial-acquired and community-onset Clostridium difficile infection at an academic hospital in Italy: Epidemiology, recurrences and toxin genes distribution. J Infect Chemother 2017; 23:763-768. [PMID: 28899610 DOI: 10.1016/j.jiac.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 01/27/2023]
Abstract
Toxinogenic Clostridium difficile infection (CDI) is a leading cause of infectious diarrhea. In this retrospective cohort study the molecular epidemiology of hospital-acquired and community-associated CDI was investigated in patients admitted to a tertiary care hospital. CD in stools samples was revealed by a two steps diagnostic algorithm, firstly screening for positivity to GDH antigen and thereafter RT-PCR analysis. Increased CDI incidence was observed ranging from 1.70episodes/10000patient-days in the 1st year, to 2.62 in the 2nd year, mostly hospitalized in the medicine wards, followed by outpatients (5.74 and 5.12episodes/10.000patient-days respectively). CDI positive were older than CDI negative patients and presented increased trend of diarrhea episodes as the patients' age increased. RT-PCR positive patients (n° = 314) were classified according to the CD toxin producing genes in three groups (1-3, carrying tcdB, both tcdB and cdt, and the two genes plus the deletion Δ117 of tcdC, respectively). The incidence of the group 2 and 3 increased statistically with the age of the patients showing correlation with the gender. Higher frequency of patients belonging to group 1 and group 3 was observed in the medical wards. Of note was the high incidence of group 3 in outpatients. Interestingly, patients with previous health care contacts had higher risk (RR = 1.88) of being infected by CD strains with higher toxicity than community patients. Recurrence rate was 15.9%. In conclusion the knowledge of the toxigenic profiles and of their relationships to gender, age and wards distribution may help the clinicians in the clinical management of the disease.
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Comparative Genome Analysis and Global Phylogeny of the Toxin Variant Clostridium difficile PCR Ribotype 017 Reveals the Evolution of Two Independent Sublineages. J Clin Microbiol 2016; 55:865-876. [PMID: 28031436 PMCID: PMC5328454 DOI: 10.1128/jcm.01296-16] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022] Open
Abstract
The diarrheal pathogen Clostridium difficile consists of at least six distinct evolutionary lineages. The RT017 lineage is anomalous, as strains only express toxin B, compared to strains from other lineages that produce toxins A and B and, occasionally, binary toxin. Historically, RT017 initially was reported in Asia but now has been reported worldwide. We used whole-genome sequencing and phylogenetic analysis to investigate the patterns of global spread and population structure of 277 RT017 isolates from animal and human origins from six continents, isolated between 1990 and 2013. We reveal two distinct evenly split sublineages (SL1 and SL2) of C. difficile RT017 that contain multiple independent clonal expansions. All 24 animal isolates were contained within SL1 along with human isolates, suggesting potential transmission between animals and humans. Genetic analyses revealed an overrepresentation of antibiotic resistance genes. Phylogeographic analyses show a North American origin for RT017, as has been found for the recently emerged epidemic RT027 lineage. Despite having only one toxin, RT017 strains have evolved in parallel from at least two independent sources and can readily transmit between continents.
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Cioni G, Viale P, Frasson S, Cipollini F, Menichetti F, Petrosillo N, Brunati S, Spigaglia P, Vismara C, Bielli A, Barbanti F, Landini G, Panigada G, Gussoni G, Bonizzoni E, Gesu GP. Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study. BMC Infect Dis 2016; 16:656. [PMID: 27825317 PMCID: PMC5101712 DOI: 10.1186/s12879-016-1961-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022] Open
Abstract
Background Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy. Methods PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2–3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1961-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giorgio Cioni
- Department of Internal Medicine, Pavullo nel Frignano Hospital, Modena, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Teaching Hospital "Policlinico S. Orsola Malpighi", Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefania Frasson
- Clinical Research Department, FADOI Foundation, Piazzale L. Cadorna, 15, Milan, Italy
| | - Francesco Cipollini
- Internal Medicine, Hospital "Vittorio Emanuele II", Amandola, Ascoli Piceno, Italy
| | | | - Nicola Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases, "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Sergio Brunati
- Department of Internal Medicine, Abbiategrasso Hospital, Milan, Italy
| | - Patrizia Spigaglia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Vismara
- Clinical Chemistry and Microbiology Laboratory, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Alessandra Bielli
- Clinical Chemistry and Microbiology Laboratory, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Fabrizio Barbanti
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giancarlo Landini
- Department of Internal Medicine, "Santa Maria Nuova" Hospital, Florence, Italy
| | - Grazia Panigada
- Department of Internal Medicine, "S.S. Cosma e Damiano" Hospital, Pescia, Pistoia, Italy
| | - Gualberto Gussoni
- Clinical Research Department, FADOI Foundation, Piazzale L. Cadorna, 15, Milan, Italy.
| | - Erminio Bonizzoni
- Section of Medical Statistics and Biometry "GA Maccacaro", Department of Clinical Science and Community, University of Milan, Milan, Italy
| | - Giovanni Pietro Gesu
- Clinical Chemistry and Microbiology Laboratory, Niguarda Ca' Granda Hospital, Milan, Italy
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A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility. Infect Control Hosp Epidemiol 2016; 37:1337-1341. [PMID: 27484769 DOI: 10.1017/ice.2016.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe and analyze a large outbreak of Clostridium difficile 027 (CD-027) infections. METHODS Confirmed CD-027 cases were defined as CD infection plus real-time polymerase chain reaction assay (PCR) positive for CD-027. Clinical and microbiological data on patients with CD-027 infection were collected from January 2013 to December 2015 in the Provence-Alpes-Côte-d'Azur region (southeastern France). RESULTS In total, 19 healthcare facilities reported 144 CD-027 infections (112 confirmed and 32 probable CD-027 infections) during a 22-month period outbreak. Although the incidence rate per 10,000 bed days was lower in long-term care facilities (LTCFs) than in acute care facilities (0.05 vs 0.14; P<.001), cases occurred mainly in LTCFs, one of which was the probable source of this outbreak. After centralization of CD testing, the rate of confirmed CD-027 cases from LTCFs or residential-care homes increased significantly (69% vs 92%; P<.001). Regarding confirmed CD-027 patients, the sex ratio and the median age were 0.53 and 84.2 years, respectively. The 30-day crude mortality rate was 31%. Most patients (96%) had received antibiotics within 3 months prior to the CD colitis diagnosis. During the study period, the rate of patients with CD-027 (compared with all patients tested in the point-of-care laboratories) decreased significantly (P=.03). CONCLUSIONS A large CD-027 outbreak occurred in southeastern France as a consequence of an initial cluster of cases in a single LTCF. Successful interventions included rapid isolation and testing of residents with potentially infectious diarrhea and cohorting of case patients in a specialized infectious diseases ward to optimize management. Infect Control Hosp Epidemiol 2016;1-5.
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Falcone M, Russo A, Iraci F, Carfagna P, Goldoni P, Vullo V, Venditti M. Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection. Antimicrob Agents Chemother 2016; 60:252-7. [PMID: 26482315 PMCID: PMC4704211 DOI: 10.1128/aac.01927-15] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/15/2015] [Indexed: 01/25/2023] Open
Abstract
We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI(+)) and those with CDI and no evidence of primary BSI (CDI/BSI(-)). Data about clinical features, microbiology, treatments, and mortality were obtained. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI, while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis, ribotype 027 status (odds ratio [OR], 6.5), CDI recurrence (OR, 5.5), severe CDI infection (OR, 8.3), and oral vancomycin at >500 mg/day (OR, 3.1) were recognized as factors independently associated with the development of nosocomial BSI. Thirty-day mortality from CDI diagnosis was higher for patients of the CDI/BSI(+) group than for the controls (38.9 versus 13.1%; P < 0.001). Among patients of the CDI/BSI(+) group, mortality attributable to primary BSI was as high as 57%. Our findings suggest that severe CDI is complicated by the development of nosocomial BSI. Candida species and enteric bacteria appear to be the leading causative pathogens and are associated with poor outcomes.
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Affiliation(s)
- Marco Falcone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Iraci
- Faculty of Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Paola Goldoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype. J Clin Microbiol 2015; 53:2575-80. [PMID: 26041894 DOI: 10.1128/jcm.00533-15] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/26/2015] [Indexed: 12/18/2022] Open
Abstract
Clostridium difficile infection (CDI) became a public health problem for the global spreading of the so-called hypervirulent PCR ribotypes (RTs) 027 and 078, associated with increases in the transmission and severity of the disease. However, especially in Europe, several RTs are prevalent, and the concept of hypervirulence is currently debated. We investigated the toxin and resistance profiles and the genetic relatedness of 312 C. difficile strains isolated in a large Italian teaching hospital during a 5-year period. We evaluated the role of CDI-related antibiotic consumption and infection control practices on the RT predominance in association with their molecular features and transmission capacity. Excluding secondary cases due to nosocomial transmission, RT018 was the predominant genotype (42.4%) followed by RT078 (13.6%), while RT027 accounted for 0.8% of the strains. RT078 was most frequently isolated from patients in intensive care units. Its prevalence significantly increased over time, but its transmission capacity was very low. In contrast, RT018 was highly transmissible and accounted for 95.7% of the secondary cases. Patients with the RT018 genotype were significantly older than those with RT078 and other RTs, indicating an association between epidemic RT and age. We provide here the first epidemiological evidence to consider RT018 as a successful epidemic genotype that deserves more attention in clinical practice.
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Di Bella S, Friedrich AW, García-Almodóvar E, Gallone MS, Taglietti F, Topino S, Galati V, Johnson E, D'Arezzo S, Petrosillo N. Clostridium difficile infection among hospitalized HIV-infected individuals: epidemiology and risk factors: results from a case-control study (2002-2013). BMC Infect Dis 2015; 15:194. [PMID: 25899507 PMCID: PMC4408587 DOI: 10.1186/s12879-015-0932-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/15/2015] [Indexed: 12/16/2022] Open
Abstract
Background HIV infection is a risk factor for Clostridium difficile infection (CDI) yet the immune deficiency predisposing to CDI is not well understood, despite an increasing incidence of CDI among such individuals. We aimed to estimate the incidence and to evaluate the risk factors of CDI among an HIV cohort in Italy. Methods We conducted a retrospective case-control (1:2) study. Clinical records of HIV inpatients admitted to the National Institute for Infectious Disease “L. Spallanzani”, Rome, were reviewed (2002-2013). Cases: HIV inpatients with HO-HCFA CDI, and controls: HIV inpatients without CDI, were matched by gender and age. Logistic regression was used to identify risk factors associated with CDI. Results We found 79 CDI episodes (5.1 per 1000 HIV hospital admissions, 3.4 per 10000 HIV patient-days). The mean age of cases was 46 years. At univariate analysis factors associated with CDI included: antimycobacterial drug exposure, treatment for Pneumocystis pneumonia, acid suppressant exposure, previous hospitalization, antibiotic exposure, low CD4 cell count, high Charlson score, low creatinine, low albumin and low gammaglobulin level. Using multivariate analysis, lower gammaglobulin level and low serum albumin at admission were independently associated with CDI among HIV-infected patients. Conclusions Low gammaglobulin and low albumin levels at admission are associated with an increased risk of developing CDI. A deficiency in humoral immunity appears to play a major role in the development of CDI. The potential protective role of albumin warrants further investigation.
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Affiliation(s)
- Stefano Di Bella
- National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy.
| | - Alexander W Friedrich
- Department of Medical Microbiology and Infection Control, University Medical Centre, Groeningen, The Netherlands.
| | | | - Maria Serena Gallone
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy.
| | - Fabrizio Taglietti
- National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy.
| | - Simone Topino
- National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy.
| | - Vincenzo Galati
- National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy.
| | | | - Silvia D'Arezzo
- National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy.
| | - Nicola Petrosillo
- National Institute for Infectious Diseases "L. Spallanzani", Via Portuense 292, 00149, Rome, Italy.
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Russo A, Falcone M, Fantoni M, Murri R, Masucci L, Carfagna P, Ghezzi MC, Posteraro B, Sanguinetti M, Venditti M. Risk factors and clinical outcomes of candidaemia in patients treated for Clostridium difficile infection. Clin Microbiol Infect 2015; 21:493.e1-4. [PMID: 25698658 DOI: 10.1016/j.cmi.2014.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/12/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
The alterations occurring in the intestinal flora during Clostridium difficile infection (CDI) may promote the translocation of Candida to the blood and the development of candidaemia. The aim of our study was to analyse clinical findings of these patients to determine the risk factors associated with the development of candidaemia subsequent to CDI. We compared 35 patients with candidaemia subsequent to CDI with 105 patients with CDI. Patients with candidaemia showed more severe infections and higher mortality. The ribotype 027 strain and vancomycin treatment at ≥ 1000 mg/day were prevalent in patients developing candidaemia. CDI may predispose to the translocation of Candida.
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Affiliation(s)
- A Russo
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Italy
| | - M Falcone
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Italy
| | - M Fantoni
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Italy
| | - R Murri
- Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Italy
| | - L Masucci
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Italy
| | - P Carfagna
- 'San Giovanni Addolorata' Hospital, Italy
| | - M C Ghezzi
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Italy
| | - B Posteraro
- Institute of Public Health (Section of Hygiene), Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Sanguinetti
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Italy.
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Giuliano S, Guastalegname M, Jenco M, Morelli A, Falcone M, Venditti M. Severe community onset healthcare-associated Clostridium difficile infection complicated by carbapenemase producing Klebsiella pneumoniae bloodstream infection. BMC Infect Dis 2014; 14:475. [PMID: 25178451 PMCID: PMC4161886 DOI: 10.1186/1471-2334-14-475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/18/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) and Klebsiella pneumoniae carbapenemase producing-Klebsiella pneumoniae (KPC-Kp) bloodstream infection (BSI) are emerging health-care associated (HCA) diseases of public health concern, in terms of morbidity, mortality, and insufficient response to antibiotic therapy. Both agents can be acquired in the hospital but clinical disease can develop in a community setting, after discharge. We report here a putative link between the above-mentioned healthcare associated infections that appeared as a dramatic community onset disease with a fulminant fatal outcome. CASE PRESENTATION We describe the case of a 63 year old man affected by severe CDI. Even though the patient underwent 72 hours of standard CDI antibiotic treatment, the clinical course was complicated by toxic megacolon and KPC-Kp BSI. The patient died 24 hours after total colectomy. CONCLUSION The impact of HCA-BSIs in complicating CDI is still unknown. Intestinal inflammatory injury and disruption of intestinal flora by standard antibiotic treatment could be responsible for promoting difficult-to-treat infections in CDI. By preserving intestinal flora, Fidaxomicin could have a crucial role in preventing BSIs complicating severe CDI.
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Affiliation(s)
| | | | | | | | | | - Mario Venditti
- Department of Public Health and Infectious Diseases Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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Lagier JC, Dubourg G, Cassir N, Fournier PE, Colson P, Richet H, Brouqui P, Raoult D. Clostridium difficile 027 emerging outbreak in Marseille, France. Infect Control Hosp Epidemiol 2014; 34:1339-41. [PMID: 24225631 DOI: 10.1086/673995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jean-Christophe Lagier
- Unité des Rickettsies et des Maladies Infectieuses et Tropicales Emergentes (URMITE), Unité Mixte 63, Centre National de la Recherche Scientifique 7278, Institut de Recherche pour le Développement 198, Institut National de la Santé et de la Recherche Médicale 1095, Aix-Marseille Université, Faculté de Médecine, Marseille, France
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Orsi GB, Conti C, Mancini C, Giordano A. Clostridium difficile 027 increasing detection in a teaching hospital in Rome, Italy. Infection 2014; 42:941-2. [PMID: 25012877 DOI: 10.1007/s15010-014-0652-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Affiliation(s)
- G B Orsi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy,
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Guastalegname M, Grieco S, Giuliano S, Falcone M, Caccese R, Carfagna P, D'ambrosio M, Taliani G, Venditti M. A cluster of fulminant Clostridium difficile colitis in an intensive care unit in Italy. Infection 2014; 42:585-9. [PMID: 24523055 DOI: 10.1007/s15010-014-0597-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/23/2014] [Indexed: 11/26/2022]
Abstract
We describe, for the first time, a cluster of lethal fulminant health-care associated Clostridium difficile (CD) colitis in Italy, observed in the intensive care unit (ICU) of an Italian tertiary care hospital in Rome. For all cases the cause of ICU admission was CD-related septic shock. Three out of seven patients were residents in a long-term care facility in Rome, and the others had been transferred to the ICU from different medical wards of the same hospital. Five patients died within 96 h of ICU admission. Because of a clinical deterioration after 4 days of adequate antibiotic therapy, two patients underwent subtotal colectomy: both of them died within 30 days of surgical intervention. In four cases, ribotyping assay was performed and ribotype 027 was recognized. This high mortality rate could be attributable to three findings: the extent of disease severity induced by the strain 027, the delay in antimicrobial therapy administration, and the lack of efficacy of the standard antibiotic treatment for fulminant CD colitis compared to an earlier surgical approach. In order to contain a CD infection epidemic, control and surveillance measures should be implemented, and empirical therapy should be administered. Because of potential 027 ribotype CD spread in Italy, CDI should be regarded with a high index of suspicion in all patients presenting with shock and signs or symptoms suggesting abdominal disease, and an early surgical approach should be considered.
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Affiliation(s)
- M Guastalegname
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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16
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Guastalegname M, Russo A, Falcone M, Giuliano S, Venditti M. Candidemia subsequent to severe infection due to Clostridium difficile: is there a link? Clin Infect Dis 2013; 57:772-4. [PMID: 23723197 DOI: 10.1093/cid/cit362] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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