Clostridioides (Clostridium) difficile infection burden in Japan: A multicenter prospective study

Kato, Haru; Senoh, Mitsutoshi; Honda, Hitoshi; Fukuda, Tadashi; Tagashira, Yasuaki; Horiuchi, Hiroko; Chiba, Hiroshi; Suzuki, Daisuke; Hosokawa, Naoto; Kitazono, Hidetaka; Norisue, Yasuhiro; Kume, Hisashi; Môri, N.; Morikawa, H.; Kashiwagura, Saeko; Higuchi, Akiko; Kato, Hideaki; Nakamura, Makoto; Saori, Ishiguro; Morita, Sayuri; Ishikawa, Hideaki; Watanabe, Takuya; Kojima, Katsuyuki; Izumi, Yokomaku; Bando, Tatsuya; Kayoko, Toimoto; Moriya, Kyoji; Kasahara, Kei; Kitada, Shuichi; Ogawa, Jun; Saito, Haruko; Tominaga, Harumi; Shimizu, Yousuke; Masumoto, Fumi; Tadera, Kayoko; Yoshida, Junichi; Kikuchi, Tetsuya; Yoshikawa, Ichiro; Watanabe, Tatsuyuki; Honda, Masahisa; Kuniko, Yokote; Toyokawa, Takao; Miyazato, Hiroko; Nakama, Mika; Mahé, Cédric; Reske, Kimberly A.; Olsen, Margaret A.; Dubberke, Erik R.

doi:10.1016/j.anaerobe.2019.03.007

Cited by 53 publications

(39 citation statements)

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“…The incidence of 1·04 cases per 10 000 patient‐days in japan was lower than that the rates of hospital‐onset CDI reported in previous multicentre studies conducted in Western countries (4·1–8·4 cases per 10 000 patient‐days) (Kobayashi et al ). However, recent studies reported no considerable difference in the incidence of CDI (Kato et al ); moreover, cases of CDI could be underdiagnosed. Mortality at 30 days has been reported to be 9–38% (Mitchell and Gardner ) in Western countries.…”

Section: Discussionmentioning

confidence: 98%

Equol inhibits growth and spore formation of Clostridioides difficile

et al. 2019

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Aims: Equol is a nonsteroidal oestrogen of the isoflavone class. We investigated the antibacterial ability of equol with respect to the growth rate, toxin production and spore-forming abilities of Clostridioides difficile BI/027/NAP1. Methods and Results: Isoflavones, or female hormones, were added to bacterial culture, which was grown at 35°C. The absorbance of the culture was measured at various time points for evaluating the growth inhibition. The toxin levels in the media and morphological changes were also assessed. To evaluate the influence of equol on the sporulation of C. difficile, cells were collected at various time points from the equol-supplemented culture and the number of spores was counted. Our results show that equol inhibits bacterial growth in a concentration-dependent manner. However, it does not inhibit the production of toxin by C. difficile. Other isoflavones and female hormones did not inhibit the C. difficile growth. At the 14th day, approximately 600 spores were present in the control medium and only six were seen in the equolcontaining medium. Conclusion: Our results suggest that equol may directly inhibit the C. difficile growth in a concentration-dependent manner and spore formation. Significance and Impact of the Study: This is the first report on the antimicrobial ability of equol.

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Section: Discussionmentioning

confidence: 98%

Equol inhibits growth and spore formation of Clostridioides difficile

et al. 2019

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Section: Discussionmentioning

confidence: 81%

“…A recent prospective study of 20 Japanese hospital wards by Kato and colleagues [30] found an overall CDI incidence (7.4/10,000 patient-days) that was higher than previously reported and suggested that patients were being missed due to inadequate CDI testing. However, the CDI incidence varied widely (from 0.6 to 75.5/ 10,000 patient-days) depending on the type of ward, as did the testing frequency (3.6e256.8/10,000 patient-days) [30]. At study end, we observed a CDI incidence of 0.99/10,000 patient-days, which is lower than that reported by the Kato study and another Japanese retrospective cohort study (3.11/10,000 patient-days) [13], as well as that estimated in a recent global systematic review (3.54/10,000 patient-days) [31].…”

Section: Discussionmentioning

confidence: 81%

Clostridioides (Clostridium) difficile infection in Japanese hospitals 2008–2017: A real-world nationwide analysis of treatment pattern, incidence and testing density

Kimura

Stanhope

Sugitani

2020

Journal of Infection and Chemotherapy

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a b s t r a c tObjective: To characterize treatment pattern, incidence and diagnosis of hospital-onset Clostridioides difficile infection (CDI) in Japan, cases were studied over a 9-year period using a large, administrative database. Methods: This was a retrospective, cross-sectional analysis of inpatients at 320 Japanese Diagnosis-Procedure Combination (DPC) hospitals. Hospitalizations between April 2008 and March 2017 were extracted for patients aged !18 years. CDI was defined as CDI treatment plus CDI diagnosis or positive enzyme immunoassay (EIA) result. Endpoints included treatment (type, route, daily dose, duration), time to CDI onset from admission, and time to recurrence (rCDI) from the end of treatment. Chronological changes were reported for treatment pattern, CDI incidence and EIA testing. Results: The analysis included 11,823 CDI hospitalizations, 1359 with rCDI. Overall, oral metronidazole (MNZ), oral vancomycin (VCM), and intravenous MNZ were used in 50.2%, 42.1% and 1.2% of CDI hospitalizations, respectively. From 2009 to 2017, CDI hospitalizations treated with MNZ more than doubled and VCM more than halved. Median (Q1eQ3) time to CDI and rCDI onset was 25 (11e52) days and 10 (6 e17.5) days, respectively. Median treatment duration ranged from 8 to 10 days and median dose was 1 g/ day for both MNZ and VCM. CDI incidence remained steady from 2010 until 2017 (0.99/10,000 patientdays) and EIA testing density doubled from 2008 to 2017 (24.46/10,000 patient-days). Conclusion: Oral MNZ has become the primary CDI treatment in Japanese DPC hospitals. The treatment duration and dose were aligned to the package insert. CDI diagnostic testing density increased over time, CDI incidence did not. Clinical trial registration number: N/A.

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“…A systematic review shows that prevalence of CDI in Japanese hospitals is lower than that of US and European countries because of under-diagnosis (Riley & Kimura, 2018). Another study shows that numerous patients with CDI are being overlooked due to inadequate diagnostic testing in Japan (Kato et al, 2019). These studies could support the first explanation.…”

Section: Discussionmentioning

confidence: 99%

Machine learning analysis to identify the association between risk factors and onset of nosocomial diarrhea: a retrospective cohort study

Kurisu

Yoshiuchi

Ogino

et al. 2019

PeerJ

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BackgroundAlthough several risk factors for nosocomial diarrhea have been identified, the detail of association between these factors and onset of nosocomial diarrhea, such as degree of importance or temporal pattern of influence, remains unclear. We aimed to determine the association between risk factors and onset of nosocomial diarrhea using machine learning algorithms.MethodsWe retrospectively collected data of patients with acute cerebral infarction. Seven variables, including age, sex, modified Rankin Scale (mRS) score, and number of days of antibiotics, tube feeding, proton pump inhibitors, and histamine 2-receptor antagonist use, were used in the analysis. We split the data into a training dataset and independant test dataset. Based on the training dataset, we developed a random forest, support vector machine (SVM), and radial basis function (RBF) network model. By calculating an area under the curve (AUC) of the receiver operating characteristic curve using 5-fold cross-validation, we performed feature selection and hyperparameter optimization in each model. According to their final performances, we selected the optimal model and also validated it in the independent test dataset. Based on the selected model, we visualized the variable importance and the association between each variable and the outcome using partial dependence plots.ResultsTwo-hundred and eighteen patients were included. In the cross-validation within the training dataset, the random forest model achieved an AUC of 0.944, which was higher than in the SVM and RBF network models. The random forest model also achieved an AUC of 0.832 in the independent test dataset. Tube feeding use days, mRS score, antibiotic use days, age and sex were strongly associated with the onset of nosocomial diarrhea, in this order. Tube feeding use had an inverse U-shaped association with the outcome. The mRS score and age had a convex downward and increasing association, while antibiotic use had a convex upward association with the outcome.ConclusionWe revealed the degree of importance and temporal pattern of the influence of several risk factors for nosocomial diarrhea, which could help clinicians manage nosocomial diarrhea.

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Clostridioides (Clostridium) difficile infection burden in Japan: A multicenter prospective study

Cited by 53 publications

References 28 publications

Equol inhibits growth and spore formation of Clostridioides difficile

Equol inhibits growth and spore formation of Clostridioides difficile

Clostridioides (Clostridium) difficile infection in Japanese hospitals 2008–2017: A real-world nationwide analysis of treatment pattern, incidence and testing density

Machine learning analysis to identify the association between risk factors and onset of nosocomial diarrhea: a retrospective cohort study

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