<i>Clostridium Difficile</i> Infection in Dialysis Patients

Tirath, Ankita; Tadros, Sandra; Coffin, Samuel L; Kintziger, Kristina W.; Waller, Jennifer L.; Baer, Stephanie L.; Colombo, Rhonda E; Huber, Lu; Kheda, Mufaddal; Nahman, N. S.

doi:10.1136/jim-2016-000183

Cited by 12 publications

(26 citation statements)

References 8 publications

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“…• long hospitalisations, • hospitalisation in an intensive care units (ICU), • immunodeficiency (acquired or congenital), • co-morbidities (e.g. chronic renal failure requiring dialysis), • steroid therapy, • chemotherapy [1][2][3][4][5][6][7][8][9][10][11].…”

Section: Risk Factorsmentioning

confidence: 99%

Clostridioides difficile infection in intensive care units in nursing practice

Fajfer-Gryz¹,

Nowak-Kózka²,

Rudek³

2020

ppiel

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Introduction: Patients hospitalised in intensive care units (ICU) are patients in severe health, who are at risk of serious hospital infections. Despite the development of medicine, developed procedures, management strategies, and high awareness of medical personnel, hospital infections are still a very big problem. One of the serious hospital infections is Clostridioides difficile, especially in ICU patients, which can even be fatal. The severity of the infection and its complications, which hamper treatment and care, are a challenge for the entire therapeutic team. At the same time, this infection is a major epidemiological threat and increases the cost of treatment. That is why the diagnosis of infection, the application of the recommended treatment, as well as the correct prevention are so important. The basis for preventing the spread of C. difficile infection is hand hygiene, the use of personal protective equipment, patient isolation, maintenance of disinfection, infected patient care, education of visitors, and monitoring and recording of infections. Aim of the study: Discussing current data on treatment in the presence of C. difficile infection and describing problems faced by ICU medical personnel. Conclusions: Following current recommendations for diagnosis and treatment and applying appropriate control procedures and methods contributes to preventing the spread of C. difficile infection in intensive care units.

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Section: Risk Factorsmentioning

confidence: 99%

Clostridioides difficile infection in intensive care units in nursing practice

Fajfer-Gryz¹,

Nowak-Kózka²,

Rudek³

2020

ppiel

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“…Some of the most vulnerable patients are those suffering from CKD and in particular with end-stage renal disease (ESRD), despite the implementation of CDI prevention strategies [ 12 ]. The majority of recently published studies indicate a greater incidence rate and mortality due to CDI in CKD, especially among those with ESRD, in comparison to the general population [ 13 , 14 , 15 ]. It also results in a significant increase in the treatment costs and prolonged hospitalization time [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Determinants Predicting Clostridioides difficile Infection among Patients with Chronic Kidney Disease

et al. 2022

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The majority of recently published studies indicate a greater incidence rate and mortality due to Clostridioides difficile infection (CDI) in patients with chronic kidney disease (CKD). The aim of this study was to assess the clinical determinants predicting CDI among hospitalized patients with CKD and refine methods of prevention. We evaluated the medical records of 279 patients treated at a nephrological department with symptoms suggesting CDI, of whom 93 tested positive for CDI. The survey showed that age, poor kidney function, high Padua prediction score (PPS) and patients’ classification of care at admission, treatment with antibiotics, and time of its duration were significantly higher or more frequent among patients who suffered CDI. Whereas BMI, Norton scale (ANSS) and serum albumin concentration were significantly lowered among CDI patients. In a multivariate analysis we proved the stage of CKD and length of antibiotics use increased the risk of CDI, whereas higher serum albumin concentration and ANSS have a protective impact.

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“…Clostridioides difficile (formerly Clostridium difficile) infection (CDI) presents with GI symptoms and has significant adverse outcomes including mortality, for both hospitalized and ambulatory patient populations [5][6][7]. Chronically ill and immunocompromised individuals, including those with end stage renal disease (ESRD), are at higher risk for developing CDI [8,9]. These statistics along with the similar presenting syndromes, pose two unique challenges in the routine clinical care of ESRD patients on PD: GI presentation with cloudy PD effluent can detract from the timely diagnosis of CDI and empirical management of PD peritonitis with routinely recommended antimicrobials including cephalosporins negatively impacts CDI.…”

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

et al. 2020

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Background: Initial presentation of peritoneal dialysis associated infectious peritonitis can be clinically indistinguishable from Clostridioides difficile infection (CDI) and both may demonstrate a cloudy dialysate. Empiric treatment of the former entails use of 3rd-generation cephalosporins, which could worsen CDI. We present a logical management approach of this clinical scenario providing examples of two cases with CDI associated peritonitis of varying severity where the initial picture was concerning for peritonitis and treatment for CDI resulted in successful cure. Case presentation: A 73-year-old male with ESRD managed with PD presented with fever, abdominal pain, leukocytosis and significant diarrhea. Cell count of the peritoneal dialysis effluent revealed 1050 WBCs/mm 3 with 71% neutrophils. C. difficile PCR on the stool was positive. Patient was started on intra-peritoneal (IP) cefepime and vancomycin for treatment of the peritonitis and intravenous (IV) metronidazole and oral vancomycin for treatment of the C. difficile colitis but worsened. PD fluid culture showed no growth. He responded well to IV tigecycline, oral vancomycin and vancomycin enemas. Similarly, a 55-year-old male with ESRD with PD developed acute diarrhea and on the third day noted a cloudy effluent from his dialysis catheter. PD fluid analysis showed 1450 WBCs/mm 3 with 49% neutrophils. IP cefepime and vancomycin were initiated. CT of the abdomen showed rectosigmoid colitis. C. difficile PCR on the stool was positive. IP cefepime and vancomycin were promptly discontinued. Treatment with oral vancomycin 125 mg every six hours and IV Tigecycline was initiated. PD fluid culture produced no growth. PD catheter was retained. Conclusions: In patients presenting with diarrhea with risk factors for CDI, traditional empiric treatment of PD peritonitis may need to be reexamined as they could have detrimental effects on CDI course and patient outcomes.

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Clostridium Difficile Infection in Dialysis Patients

Cited by 12 publications

References 8 publications

Clostridioides difficile infection in intensive care units in nursing practice

Clostridioides difficile infection in intensive care units in nursing practice

Clinical Determinants Predicting Clostridioides difficile Infection among Patients with Chronic Kidney Disease

Clostridioides difficile associated peritonitis in peritoneal dialysis patients – a case series based review of an under-recognized entity with therapeutic challenges

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