Changing Clostridium difficile infection testing and treatment trends at a large tertiary care teaching hospital

Salazar, Miguel; Garey, Kevin W.; Jiang, Zhi‐Dong; Dao-Tran, T. K.; DuPont, Herbert L.

doi:10.1007/s11096-009-9316-x

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…This study demonstrated that the prevalence of CDI in at risk adult hospitalized patients (patients with diarrhea with no other identifiable cause and recent antimicrobial exposure) in two large hospitals in Bangladesh was 9%. This prevalence is similar to that reported in other South Asian countries and the United States [11,22,23]. Clinicians at these two hospitals were not testing for C. difficile until this study was conducted, highlighting the importance of this under-diagnosis.…”

Section: Discussionsupporting

confidence: 82%

Molecular epidemiology of toxigenic Clostridioides difficile isolates from hospitalized patients and the hospital environment in Dhaka, Bangladesh

et al. 2020

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Epidemiology of Clostridioides difficile (syn. Clostridium difficile) infection (CDI) in Bangladesh is poorly understood. This study assessed the epidemiology of CDI in hospitalized patients and hospital environmental contamination of toxigenic C. difficile at two large urban Bangladesh hospitals. This 12-month prospective observational cohort study collected stool samples from adults with diarrhea and recent antimicrobial exposure during 2017. Environmental samples were collected by swabbing surfaces of hospital common areas. Samples underwent toxigenic culture. C. difficile isolates were tested for toxins A and B and PCR-ribotyped. Of 208 stool samples, 18 (8.7%) were positive for toxigenic C. difficile. Of 400 environmental samples, 45 (11%) were positive for toxigenic C. difficile. Ribotypes present in ≥10% of stool isolates were 017 (38%), 053-163 (13%), and a novel ribotype (FP435 [13%]). Common ribotypes in environmental isolates were 017 (22%), 053-163 (11%), 106 (24%). This is the first report describing current epidemiology of CDI in at risk hospitalized adult patients in Bangladesh.

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Section: Discussionsupporting

confidence: 82%

Molecular epidemiology of toxigenic Clostridioides difficile isolates from hospitalized patients and the hospital environment in Dhaka, Bangladesh

et al. 2020

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“…In contrast with this literature demonstrating a temporal increase in incidence in IBD and non‐IBD patients, there has been limited examination of change in characteristics of affected patients or outcomes after C. difficile infection over the past decade. In one such analysis not restricted to IBD patients, Salazar et al22 did not find a difference in the demographic characteristics of C. difficile ‐positive patients in 2005–2006 compared to 2006–2007 at a single tertiary referral center. In the present study, while there was no difference in mean age of C. difficile‐ IBD patients across the three study years, there was a modest increase in the general comorbidity as measured using the Elixhauser index.…”

Section: Discussionmentioning

confidence: 97%

Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease

Ananthakrishnan

McGinley

Saeian

et al. 2011

Inflammatory Bowel Diseases

133

100

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“…Previous study in a large tertiary care teaching hospital in U.S. reported that metronidazole was the most commonly used drug (81.6%) for CDI treatment. 18 Study in a French university hospital also reported metronidazole alone was used in 73.5% for CDI treatment despite severe CDI was observed in 53.9% of all CDI patients. 19 In our study, metronidazole was started in 83.9% of CDI cases because most patients had non-severe CDI.…”

Section: Discussionmentioning

confidence: 99%

Medication use evaluation for Clostridium difficile infection: a case of super tertiary care hospital in northeastern Thailand

Soontornpas¹,

Mootsikapun²,

Soontornpas³

2021

Pharm Sci Asia

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Clostridium difficile infection (CDI) is a common and serious nosocomial infection worldwide. It is also problem in our hospital, a medical school in Khon Kaen University. Rationale use of antimicrobial in the treatment of CDI is still being questionable. This study aimed to explore the characteristic and evaluate the treatment of CDI in our setting. This retrospective cohort study was performed in 168 CDI patients admitted at Srinagarind Hospital between October 2013 and September 2016. Patient medical records were reviewed for demographics, comorbidities, antimicrobial exposures, treatments and clinical outcomes. Antimicrobial therapy for CDI was then evaluated in accordance with the current CDI guideline. Most CDI patients aged over 50 years (72.6%) and 42.8% aged over 65 years. Common comorbidities in the patients were cardiovascular disease (47.6%), diabetes mellitus (27.4%), chronic kidney disease (20.8%), malignancy (16.7%), cerebrovascular disease (11.3%), chronic hepatitis (3.6%) and chronic obstructive pulmonary disease (2.4%). Patients who had taken antimicrobial during hospitalization prior to CDI diagnosis constituted 83.9% of total study population. Metronidazole, vancomycin and both were initial therapy in 83.9, 4.8 and 11.3% of CDI, respectively. Appropriateness of CDI treatment in all terms was 44% and recovery rate was 62% of assessable cases. Nine patients (5.4%) died during hospitalization. In conclusion, most patients had CDI risk factors including elderly, comorbidity, antimicrobial exposure, and prolonged hospital stay. Inappropriate CDI treatment was found in asymptomatic carriers or inappropriate treatment duration. Initial therapy with metronidazole should change to oral vancomycin which was the first-line therapy in the current guidelines.

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Changing Clostridium difficile infection testing and treatment trends at a large tertiary care teaching hospital

Abstract: Increased rates of CDI testing and use of alternative therapies was observed at a time when the hypervirulent strain was first identified.

Cited by 7 publications

References 26 publications

Molecular epidemiology of toxigenic Clostridioides difficile isolates from hospitalized patients and the hospital environment in Dhaka, Bangladesh

Molecular epidemiology of toxigenic Clostridioides difficile isolates from hospitalized patients and the hospital environment in Dhaka, Bangladesh

Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease

Medication use evaluation for Clostridium difficile infection: a case of super tertiary care hospital in northeastern Thailand

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