Hospital Infection Control: Clostridioides difficile

Turner, Nicholas; Anderson, Deverick J.

doi:10.1055/s-0040-1701234

Cited by 24 publications

(17 citation statements)

References 124 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clostridioides ( Clostridium ) difficile is a spore-forming, gram-positive, and anaerobic bacillus found in the environment and in the intestinal tract of animals and humans. In humans, the infection is the leading cause of antibiotic-associated diarrhea and of a wide range of gastrointestinal syndromes ( Knight et al, 2015 ; Turner and Anderson, 2020 ). The molecular epidemiology of C. difficile infection (CDI) has shown that the bacterial genome and the disease have become very variable in the last decades.…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Antimicrobial Resistance of Clostridioides difficile in Hospitalized Patients From Mexico

et al. 2022

View full text Add to dashboard Cite

Clostridioides difficile is a global public health problem, which is a primary cause of antibiotic-associated diarrhea in humans. The emergence of hypervirulent and antibiotic-resistant strains is associated with the increased incidence and severity of the disease. There are limited studies on genomic characterization of C. difficile in Latin America. We aimed to learn about the molecular epidemiology and antimicrobial resistance in C. difficile strains from adults and children in hospitals of México. We studied 94 C. difficile isolates from seven hospitals in Mexico City from 2014 to 2018. Whole-genome sequencing (WGS) was used to determine the genotype and examine the toxigenic profiles. Susceptibility to antibiotics was determined by E-test. Multilocus sequence typing (MLST) was used to determine allelic profiles. Results identified 20 different sequence types (ST) in the 94 isolates, mostly clade 2 and clade 1. ST1 was predominant in isolates from adult and children. Toxigenic strains comprised 87.2% of the isolates that were combinations of tcdAB and cdtAB (tcdA+/tcdB+/cdtA+/cdtB+, followed by tcdA+/tcdB+/cdtA−/cdtB−, tcdA−/tcdB+/cdtA−/ cdtB−, and tcdA−/tcdB−/cdtA+/cdtB+). Toxin profiles were more diverse in isolates from children. All 94 isolates were susceptible to metronidazole and vancomycin, whereas a considerable number of isolates were resistant to clindamycin, fluroquinolones, rifampicin, meropenem, and linezolid. Multidrug-resistant isolates (≥3 antibiotics) comprised 65% of the isolates. The correlation between resistant genotypes and phenotypes was evaluated by the kappa test. Mutations in rpoB and rpoC showed moderate concordance with resistance to rifampicin and mutations in fusA substantial concordance with fusidic acid resistance. cfrE, a gene recently described in one Mexican isolate, was present in 65% of strains linezolid resistant, all ST1 organisms. WGS is a powerful tool to genotype and characterize virulence and antibiotic susceptibility patterns.

show abstract

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Antimicrobial Resistance of Clostridioides difficile in Hospitalized Patients From Mexico

et al. 2022

View full text Add to dashboard Cite

show abstract

“… 24 Antibiotic exposure is the most common trigger, as it disrupts the normal bowel flora. 25 Though most of the older studies do not mention C. difficile , Grover et al terminated their study early due to concerns from recent publications linking clindamycin usage to C. difficile infections. 11 Most recently, Cook et al reported no difference in C. difficile colitis between the antibiotic prophylaxis and control groups, which is consistent with reported increases in community-acquired cases.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma

Freeman

Asfaw

Vatsaas

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundAntibiotic prophylaxis is routinely administered for most operative procedures, but their utility for certain bedside procedures remains controversial. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether trauma patients receiving tube thoracostomy (TT) for traumatic hemothorax or pneumothorax should receive antibiotic prophylaxis.MethodsPublished literature was searched through MEDLINE (via PubMed), Embase (via Elsevier), Cochrane Central Register of Controlled Trials (via Wiley), Web of Science and ClinicalTrials.gov databases by a professional librarian. The date ranges for our literature search were January 1900 to March 2020. A systematic review and meta-analysis of currently available evidence were performed using the Grading of Recommendations Assessment, Development and Evaluation methodology.ResultsFourteen relevant studies were identified and analyzed. All but one were prospective, with eight being prospective randomized control studies. Antibiotic prophylaxis protocols ranged from a single dose at insertion to 48 hours post-TT removal. The pooled data showed that patients who received antibiotic prophylaxis were significantly less likely to develop empyema (OR 0.47, 95% CI 0.25 to 0.86, p=0.01). The benefit was greater in patients with penetrating injuries (penetrating OR 0.25, 95% CI 0.10 to 0.59, p=0.002, vs blunt OR 0.25, 95% CI 0.06 to 1.12, p=0.07). Administration of antibiotic prophylaxis did not significantly affect pneumonia incidence or mortality.DiscussionIn adult trauma patients who require TT insertion, we conditionally recommend antibiotic prophylaxis be given at the time of insertion to reduce incidence of empyema.PROSPERO registration numberCRD42018088759.

show abstract

“…First, this could reflect a commitment by health care organizations in reducing the infection rates by taking increasingly aggressive measures to prevent CDI. Adherence to infection control measures, such as handwashing, contact precautions, and patient isolation, environmental screening and cleaning, and the use of sporicidal germicides, [21][22][23] may have improved over time and are potentially modifiable with hospital-based initiatives. For example, Vaughn et al 24 found an increase in reported use of infection prevention practices against CDI in Veterans Affairs hospitals.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Federal Value-Based Incentive Programs and In-Hospital Clostridioides difficile Infection Rates

et al. 2021

View full text Add to dashboard Cite

IMPORTANCEHealth care facility-onset Clostridioides difficile infection (HO-CDI) rates reported to the US Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) became a target quality metric for 2 Centers for Medicare & Medicaid Services (CMS) value-based incentive programs (VBIPs) in October 2016. The association of VBIPs with HO-CDI rates is unknown. OBJECTIVE To examine the association between VBIP implementation and HO-CDI rates. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series study evaluated HO-CDI rates among adults hospitalized from January 2013 to March 2019 at 265 acute-care hospitals. INTERVENTIONS Implementation of VBIPs in October 2016. MAIN OUTCOMES AND MEASURES Quarterly rates of HO-CDI per 10 000 patient-days, as reported to NHSN by participating hospitals, were evaluated. Generalized estimating equations were used to fit negative binomial regression models to estimate immediate program effect size (ie, level change) and changes in the slope of HO-CDI rates, controlling for each hospital's predominant method of CDI testing (ie, nucleic acid amplification test [NAAT], enzyme immunoassay [EIA] for toxin, or other testing methods). RESULTSThe study cohort included 24 332 938 admissions, 109 371 136 patient-days, and 74 681 HO-CDI events at 265 hospitals (145 [55%] with 100-399 beds; 205 [77%] not-for-profit hospitals; 185 [70%] teaching hospitals; 229 [86%] in metropolitan areas). Compared with EIA, rates of HO-CDI were higher when detected by NAAT (adjusted incidence rate ratio [aIRR], 1.55; 95% CI, 1.40-1.70; P < .001) and other testing methods (aIRR, 1.47; 95% CI, 1.26-1.71; P < .001). There were no significant changes in testing methods used by hospitals immediately after VBIP implementation.Controlling for CDI testing method, VBIP implementation was associated with a 6% level decline in HO-CDI rates in the immediate postpolicy quarter (aIRR, 0.94; 95% CI, 0.89-0.99; P = .01) and a 4% decline in slope per quarter (aIRR, 0.96; 95% CI, 0.95-0.97; P < .001). Results were similar in a sensitivity analysis using a 1-year roll-in period accounting for the period after the announcement of the HO-CDI VBIP policy and prior to its implementation. CONCLUSIONS AND RELEVANCEIn this study, VBIP implementation was associated with improvements in HO-CDI rates, independent of CDI testing method. Given that CMS payment policies have not previously been associated with improvements in other targeted health careassociated infection rates, future research should focus on elucidating the specific processes that contributed to improvement in HO-CDI rates to inform the design of future VBIP interventions.

show abstract

Hospital Infection Control: Clostridioides difficile

Cited by 24 publications

References 124 publications

Molecular Epidemiology and Antimicrobial Resistance of Clostridioides difficile in Hospitalized Patients From Mexico

Molecular Epidemiology and Antimicrobial Resistance of Clostridioides difficile in Hospitalized Patients From Mexico

Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma

Assessment of Federal Value-Based Incentive Programs and In-Hospital Clostridioides difficile Infection Rates

Contact Info

Product

Resources

About