Clostridium difficile Skin Contamination in Patients with C. difficile-Associated Disease

Bobulsky, Greg S.; Al‐Nassir, Wafa N.; Riggs, Michelle M.; Sethi, Ajay K.; Donskey, Curtis J.

doi:10.1086/525267

Cited by 101 publications

(66 citation statements)

References 15 publications

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“…C. diffi cile can also be cultured from the surfaces of rooms of patients with asymptomatic CDI, albeit to a lesser degree than from the rooms of patients with symptomatic CDI. Additionally; it has been shown that the skin surfaces of patients with CDI diarrhea that resolved 2 weeks before is still contaminated with C. diffi cile that may be transferred to an examining gloved hand ( 177 ). One recommendation is to maintain contact precautions for 48 h aft er diarrhea ceases ( 178 ).…”

Section: Management Of CDI and Co-morbid Conditionsmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,478

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Management Of CDI and Co-morbid Conditionsmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,478

1,408

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“…Los focos que contribuyen a la diseminación de las esporas en el ambiente hospitalario son diversos. Estudios han demostrado que el personal médico puede actuar como vector de transmisión de esporas de C. difficile 26,45,46 . Recientemente, Landelle y cols.…”

Section: Esporas De C Difficile Como Vector De Transmisiónunclassified

“…47 , observaron que cerca de 25% del personal a cargo del cuidado de pacientes con IACD tenía sus manos contaminadas con esporas de C. difficile debido al no uso de guantes. Los pacientes con IACD son considerados diseminadores de esporas de C. difficile, a través de sus deposiciones, piel y ropa 26,45,46 . Debido a esto, es vital un diagnóstico temprano de los casos de IACD, lo que permite identificarlos oportunamente y aislarlos.…”

Section: Esporas De C Difficile Como Vector De Transmisiónunclassified

Esporas de Clostridium difficile y su relevancia en la persistencia y transmisión de la infección

Barra-Carrasco

Hernández-Rocha

Ibáñez

et al. 2014

Rev. chil. infectol.

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Clostridium difficile spores and its relevance in the persistence and transmission of the infection C. difficile is an anaerobic spore former pathogen and the most important etiologic agent of nosocomial and community acquired antibiotics associated diarrheas. C. difficile infections (CDI) are responsible for an elevated rate of morbidity in developed and developing countries. Although the major virulence factors responsible for clinical symptoms of CDI are the two toxins TcdA and TcdB, C. difficile spores are the main vehicle of infection, persistence and transmission of CDI. Recent work has unrevealed unique properties of C. difficile spores that make them remarkable morphotypes of persistence and transmission in the host, including their resistance to antibiotics, the host immune response and disinfectants. The present review summarizes relevant aspects of C. difficile spore biology that have major implications from a clinical and medical perspective.

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“…Do not wear the same pair of gloves for the care of more than one patient (IB). 73,114,123,139,520,941,1021 D. When wearing gloves, change or remove gloves during patient care if moving from a contaminated body site to either another body site (including non-intact skin, mucous membrane or medical device) within the same patient or the environment (II). 72,123,139 E. The reuse of gloves is not recommended (IB).…”

Section: Use Of Glovesmentioning

confidence: 99%

Hand Hygiene

Longtin¹,

Sax²,

Allegranzi³

et al. 2011

N Engl J Med

108

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Clostridium difficile Skin Contamination in Patients with C. difficile-Associated Disease

Cited by 101 publications

References 15 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Esporas de Clostridium difficile y su relevancia en la persistencia y transmisión de la infección

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