Impact of Clostridium difficile infection caused by the NAP1/RT027 strain on severity and recurrence during an outbreak and transition to endemicity in a Mexican tertiary care center

Tamez-Torres, Karla M; Torres-González, Pedro; Leal-Vega, Francisco; García-Alderete, Ariana; García, Norma Irene López; Mendoza-Aguilar, Raquel; Bobadilla-del-Valle, Miriam; León, Alfredo Ponce de; Sifuentes–Osornio, José

doi:10.1016/j.ijid.2017.09.022

Cited by 23 publications

(5 citation statements)

References 40 publications

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“…difficile /Epi test, Cepheid, Sunnyvale, California, United States). This testing algorithm has been in use in the hospital since 2013 (in previous years, the GDH assay had been followed by the VIDAS ® CD A&B toxin detection kit) [ 15 ]. All cases were diagnosed by the treating physicians and were registered by the Department of Hospital Epidemiology, according to routine active epidemiological surveillance policies.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI) in a Mexican tertiary care hospital: A case-control study

et al. 2018

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ObjectiveTo identify clinical and environmental factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI).DesignCase-control study.SettingPublic, acute care, academic tertiary referral center in Mexico.PatientsAdults hospitalized ≥48 hours between January 2015 and December 2016 were included. Cases were patients with a first episode of HO-HCFA CDI. Controls were patients with any other diagnosis; they were randomly selected from the hospital discharge database and matched in a 1:2 manner according to the date of diagnosis of case ± 10 days. Variables with p<0.1 were considered for multivariable analysis.ResultsOne hundred and fifty-five cases and 310 controls were included. Variables independently associated with HO-HCFA CDI were: exposure to both ciprofloxacin and proton pump inhibitor (PPI) within the last 3 months (OR = 8.07, 95% CI = 1.70–38.16), febrile neutropenia (OR = 4.61, 95% CI = 1.37–15.46), intraabdominal infection (OR = 2.06, 95% CI = 0.95–4.46), referral from other hospitals (OR = 1.99, 95% CI = 0.98–4.05) and an increasing number of antibiotics previously used (OR = 1.28, 95% CI = 1.13–1.46).ConclusionsMultiple factors were found to be associated with the first episode of HO-HCFA CDI in the setting of an outbreak; of the modifiable risk factors, prior exposure to both ciprofloxacin and PPI was the most important. Referral from other hospitals was an environmental risk factor that deserves further study.

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Section: Methodsmentioning

confidence: 99%

Factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI) in a Mexican tertiary care hospital: A case-control study

et al. 2018

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“…Though an association is postulated, explanatory and predictive modeling studies differ on whether infection with the R027 strain of C. difficile increases rCDI risk [7,40,49,[58][59][60][61]. This may be due to differences in patient populations, the presence of phenotypically distinct lineages/subtypes within R027 [62,63], or the diagnostic methods used.…”

Section: Clostridioides Difficile Attributes and Biomarkersmentioning

confidence: 99%

Can prediction scores be used to identify patients at risk of Clostridioides difficile infection?

Rao

Dubberke

2021

Current Opinion in Gastroenterology

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Purpose of reviewTo describe the current state of literature on modeling risk of incident and recurrent Clostridioides difficile infection (iCDI and rCDI), to underscore limitations, and to propose a path forward for future research. Recent findingsThere are many published risk factors and models for both iCDI and rCDI. The approaches include scores with a limited list of variables designed to be used at the bedside, but more recently have also included automated tools that take advantage of the entire electronic health record. Recent attempts to externally validate scores have met with mixed success. SummaryFor iCDI, the performance largely hinges on the incidence, which even for hospitalized patients can be low (often <1%). Most scores fail to achieve high accuracy and/or are not externally validated. A challenge in predicting rCDI is the significant overlap with risk factors for iCDI, reducing the discriminatory ability of models. Automated electronic health record-based tools show promise but portability to other centers is challenging. Future studies should include external validation and consider biomarkers to augment performance.

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“…Clostridium difficile (C. difficile), a strictly anaerobic, sporeforming Gram-positive (G + ) bacterium, is the major cause of C. difficile infections (CDI) such as antibiotic-associated diarrhea, pseudomembranous colitis, and C. difficile-associated diarrhea (Burke and Lamont 2014). In the past decades, the emergence of C. difficile high virulence epidemic strains had resulted in increased morbidity and mortality worldwide (Tamez-Torres et al 2017). According to a statistics from 2011 to 2013 in the USA, CDI infected an average of 250,000 people a year, with a mortality rate of 5.6% (Lessa et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Design and characterization of a novel lytic protein against Clostridium difficile

Wang

Deng

et al. 2022

Appl Microbiol Biotechnol

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Clostridium difficile (C. difficile) is a Gram-positive, spore-forming, toxin-producing anaerobe that can cause nosocomial antibiotic-associated intestinal disease. Autolysin is a lytic enzyme that hydrolyzes peptidoglycans of the bacterial cell wall, with a catalytic domain and cell wall-binding domains, proven to be involved in bacterial cell wall remodeling and cell division. Although autolysins in C. difficile have been reported, the autolysins have failed to yield impressive results when used as exogenous lytic agents. In this study, we expressed and characterized the binding domains (Cwp19-BD and Acd-BD) and catalytic domains (Cwp19-CD, Acd-CD, and Cwl-CD) of C. difficile autolysins, and the domains with the best binding specificity and lytic activity were selected towards C. difficile to design a novel lytic protein Cwl-CWB2. Cwl-CWB2 showed good biosafety with significantly low hemolysis and without cytotoxicity. The results of fluorescence analysis and lytic assay demonstrated that Cwl-CWB2 has higher binding specificity and stronger lytic activity with a minimum inhibitory concentration at 13.39 ± 5.80 μg/mL against living C. difficile cells, which is significantly stronger than commercial lysozyme (3333.33 ± 1443.37 μg/mL) and other reported C. difficile autolysins. Besides, Cwl-CWB2 exhibited good stability as about 75% of the lytic activity was still retained when incubated at 37 °C for 96 h, which is considered to be a potential antimicrobial agent to combat C. difficile. Key points• Several binding domains and catalytic domains, deriving from several Clostridium difficile autolysins, were expressed, purified, and functionally characterized.• A novel C. difficile lytic protein Cwl-CWB2 was designed from C. difficile autolysins.• The binding specificity and lytic activity of Cwl-CWB2 against C. difficile showed advantages compared with other reported C. difficile autolysins.• Cwl-CWB2 exhibited significantly low hemolysis and cytotoxicity against normal-derived colon mucosa 460 cell.

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Impact of Clostridium difficile infection caused by the NAP1/RT027 strain on severity and recurrence during an outbreak and transition to endemicity in a Mexican tertiary care center

Cited by 23 publications

References 40 publications

Factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI) in a Mexican tertiary care hospital: A case-control study

Factors associated with an outbreak of hospital-onset, healthcare facility-associated Clostridium difficile infection (HO-HCFA CDI) in a Mexican tertiary care hospital: A case-control study

Can prediction scores be used to identify patients at risk of Clostridioides difficile infection?

Design and characterization of a novel lytic protein against Clostridium difficile

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