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Leitner E, Schreiner E, Neuhold M, Bozic M, Pux C, Pichler G, Schippinger W, Steinmetz I, Krause R, Zollner-Schwetz I. Low prevalence of Clostridium difficile colonization in patients in long-term care facilities in Graz, Austria: A point-prevalence study. Am J Infect Control 2020; 48:1144-1147. [PMID: 31917013 DOI: 10.1016/j.ajic.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND We aimed to determine the prevalence of asymptomatic colonization by C. difficile in stool of residents in four long-term care facilities (LTCFs) in Graz, Austria and to identify factors associated with colonization. METHODS We conducted a point-prevalence study in March 2018. Stool samples were examined by GDH enzyme immunoassay and when positive a toxin A/B-enzyme immunoassay was carried out. Additionally, all samples were tested by toxin A and B PCR and were plated manually as well as in automated fashion onto selective C. difficile agar. RESULTS In 4/144 (2.8%) residents the GDH assay was positive. Each resident was colonized by a different C. difficile ribotype. C. difficile was not detected in any of the environmental samples. Significantly more colonized residents (60%) had stayed at a hospital in the 3 months previous to the study compared to 10% of non-colonized patients (p=0.01). CONCLUSIONS The prevalence of colonization by toxigenic C. difficile was 2.8% in patients in LTCFs in Graz, Austria.
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Seugendo M, Janssen I, Lang V, Hasibuan I, Bohne W, Cooper P, Daniel R, Gunka K, Kusumawati RL, Mshana SE, von Müller L, Okamo B, Ortlepp JR, Overmann J, Riedel T, Rupnik M, Zimmermann O, Groß U. Prevalence and Strain Characterization of Clostridioides (Clostridium) difficile in Representative Regions of Germany, Ghana, Tanzania and Indonesia - A Comparative Multi-Center Cross-Sectional Study. Front Microbiol 2018; 9:1843. [PMID: 30131799 PMCID: PMC6090210 DOI: 10.3389/fmicb.2018.01843] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/24/2018] [Indexed: 12/20/2022] Open
Abstract
Clostridioides (Clostridium) difficile infections (CDI) are considered worldwide as emerging health threat. Uptake of C. difficile spores may result in asymptomatic carrier status or lead to CDI that could range from mild diarrhea, eventually developing into pseudomembranous colitis up to a toxic megacolon that often results in high mortality. Most epidemiological studies to date have been performed in middle- and high income countries. Beside others, the use of antibiotics and the composition of the microbiome have been identified as major risk factors for the development of CDI. We therefore postulate that prevalence rates of CDI and the distribution of C. difficile strains differ between geographical regions depending on the regional use of antibiotics and food habits. A total of 593 healthy control individuals and 608 patients suffering from diarrhea in communities in Germany, Ghana, Tanzania and Indonesia were selected for a comparative multi-center cross-sectional study. The study populations were screened for the presence of C. difficile in stool samples. Cultured C. difficile strains (n = 84) were further subtyped and characterized using PCR-ribotyping, determination of toxin production, and antibiotic susceptibility testing. Prevalence rates of C. difficile varied widely between the countries. Whereas high prevalence rates were observed in symptomatic patients living in Germany and Indonesia (24.0 and 14.7%), patients from Ghana and Tanzania showed low detection rates (4.5 and 6.4%). Differences were also obvious for ribotype distribution and toxin repertoires. Toxin A+/B+ ribotypes 001/072 and 078 predominated in Germany, whereas most strains isolated from Indonesian patients belonged to toxin A+/B+ ribotype SLO160 and toxin A-/B+ ribotype 017. With 42.9–73.3%, non-toxigenic strains were most abundant in Africa, but were also found in Indonesia at a rate of 18.2%. All isolates were susceptible to vancomycin and metronidazole. Mirroring the antibiotic use, however, moxifloxacin resistance was absent in African C. difficile isolates but present in Indonesian (24.2%) and German ones (65.5%). This study showed that CDI is a global health threat with geographically different prevalence rates which might reflect distinct use of antibiotics. Significant differences for distributions of ribotypes, toxin production, and antibiotic susceptibilities were observed.
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Affiliation(s)
- Mwanaisha Seugendo
- Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Iryna Janssen
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
| | - Vanessa Lang
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
| | - Irene Hasibuan
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
| | - Wolfgang Bohne
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
| | | | - Rolf Daniel
- Department of Genomic and Applied Microbiology, University of Göttingen, Göttingen, Germany
| | - Katrin Gunka
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
| | - R L Kusumawati
- Department of Microbiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Stephen E Mshana
- Department of Medical Microbiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Lutz von Müller
- Institute of Medical Microbiology, Saarland University, Homburg, Germany
| | - Benard Okamo
- Department of Medical Microbiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Jörg Overmann
- Department Microbial Ecology and Diversity Research, Leibniz Institute DSMZ, Braunschweig, Germany
| | - Thomas Riedel
- Department Microbial Ecology and Diversity Research, Leibniz Institute DSMZ, Braunschweig, Germany
| | - Maja Rupnik
- Institute of Public Health Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Ortrud Zimmermann
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
| | - Uwe Groß
- Institute of Medical Microbiology, University Medical Center Göttingen Göttingen, Germany
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Clostridium difficile Exposures, Colonization, and the Microbiome: Implications for Prevention. Infect Control Hosp Epidemiol 2018; 39:596-602. [PMID: 29553000 DOI: 10.1017/ice.2018.36] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
New studies have been published regarding the epidemiology of Clostridium difficile in topics such as asymptomatic C. difficile colonization, community-associated C. difficile infection, environmental contamination outside healthcare settings, animal colonization, and the interactions between C. difficile and the gut microbiome. In addition to summarizing these findings, this review offers a perspective on the potential impact of high-throughput sequencing and other potential techniques on the prevention of C. difficile.Infect Control Hosp Epidemiol 2018;39:596-602.
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Behar L, Chadwick D, Dunne A, Jones CI, Proctor C, Rajkumar C, Sharratt P, Stanley P, Whiley A, Wilks M, Llewelyn MJ. Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival. J Infect 2017; 75:20-25. [PMID: 28435086 PMCID: PMC5464213 DOI: 10.1016/j.jinf.2017.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To establish risk factors for Clostridium difficile colonization among hospitalized patients in England. METHODS Patients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stool sample as soon as possible after enrolment and then weekly during their hospital stay. Samples were cultured for C. difficile before ribotyping and toxin detection by PCR. A multivariable logistic regression model of risk factors for C. difficile colonization was fitted from univariable risk factors significant at the p < 0.05 level. RESULTS 410/727 participants submitted ≥1 stool sample and 40 (9.8%) carried toxigenic C. difficile in the first sample taken. Ribotype 106 was identified three times and seven other ribotypes twice. No ribotype 027 strains were identified. Independent predictors of colonization were previous C. difficile infection (OR 4.53 (95% C.I. 1.33-15.48) and malnutrition (MUST score ≥2) (OR 3.29 (95% C.I. 1.47-7.35)). Although C. difficile colonised patients experienced higher 90-day mortality, colonization was not an independent risk for death. CONCLUSIONS In a non-epidemic setting patients who have previously had CDI and have a MUST score of ≥2 are at increased risk of C. difficile colonization and could be targeted for active surveillance to prevent C. difficile transmission.
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Affiliation(s)
- Laura Behar
- Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom
| | - David Chadwick
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, United Kingdom
| | - Angela Dunne
- Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom
| | - Christopher I Jones
- Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, BN1 9PS, United Kingdom
| | - Claire Proctor
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, United Kingdom
| | - Chakravarthi Rajkumar
- Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom; Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, BN1 9PS, United Kingdom
| | - Paula Sharratt
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
| | - Philip Stanley
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
| | - Angela Whiley
- Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, 4, Newark Street, London, E1 2AT, United Kingdom
| | - Mark Wilks
- Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, 4, Newark Street, London, E1 2AT, United Kingdom; Department of Infection, Barts Health NHS Trust, Pathology and Pharmacy, 80, Newark St, London, E1 2ES, United Kingdom
| | - Martin J Llewelyn
- Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom; Brighton and Sussex Medical School, University of Sussex, Falmer, East Sussex, BN1 9PS, United Kingdom.
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