Increasing Hospitalization and Death Possibly Due to<i>Clostridium difficile</i>Diarrheal Disease

Frost, Floyd J.; Craun, Gunther F.; Calderon, Rebecca L.

doi:10.3201/eid0404.980412

Cited by 38 publications

(25 citation statements)

References 10 publications

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“…5 The incidence of C. difficile infection and its associated complications including mortality is on the rise world-wide. [7][8][9] The reasons for the increasing incidence of C. difficile infection are not clear.P ossible explanations include increasing and irrational use of antibiotics, long-term use of PPI, increasing elderly population, overcrowding of hospitals, poor compliance with hand hygiene and environmental cleaning standards, and the emergence of antibiotic resistant and virulent strains of C. difficile. [10][11][12][13] The role of the level of awareness of doctors, nurses and other healthcare workers in the increasing incidence of C. difficile infection is not clear.H igh levels of awareness among hospital staff might reduce the number of infected cases and C. difficile infection associated morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile: How Much do Hospital Staff Know About it?

Aroori

Blencowe

Pye

et al. 2009

annals

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Ann RC oll Surg Engl 2009; 91:4 64-469 464Clostridium difficile is an opportunistic, Gram-positive, anaerobic, spore-formingb acillus. Its clinical effects can range from mild self-limiting diarrhoea to life-threatening toxic megacolon and peritonitis. After methicillin-resistant Staphylococcus aureus infection (MRSA), C. difficile is the most wide-spread hospital acquired infection in the UK. In the UK, MRSA infection rates are declining, but rates of C. difficile infection continue to rise. There are several reasons for the increasing incidence of C. difficile infection. One possible reason could be lack of awareness and adequate knowledge among healthcare professionals. There are no studies in the literature that examined the level of healthcare professional's knowledge about C. difficile infection. We,t herefore,c onducted aq uestionnaire-based survey within our hospital to address this issue. Subjects and MethodsAq uestionnaire-based survey was conducted in Weston General Hospital, UK, in January 2007. Eligible participants included doctors, nurses, dieticians, physiotherapists, and theatre staff. Participants were recruited on av oluntary SUBJECTS AND METHODS At otal of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using aq uestionnaire consisting of 17 questions covering various aspects of C. difficile. GENERAL SURGERYRESULTS More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P =0 .001) were aware of the spectrum of illnesses causedb yC. difficile.S even (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6( 33%) consultants, 21 (53%) trainees (P =n ot significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P =0 .05) and 70% of nurses correctly answered that oral metronidazolei st he drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P <0 .0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection.CONCLUSIONS There is as ignificant...

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Section: Discussionmentioning

confidence: 99%

Clostridium difficile: How Much do Hospital Staff Know About it?

Aroori

Blencowe

Pye

et al. 2009

annals

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“…For patients whose hospital stay is complicated by C. difficile-associated diarrhoea (CDAD) a prolonged hospital stay, and additional diagnostic and therapeutic procedures, leading to increasing health care costs, were reported (Kyne et al, 2002). Increased hospitalization and death possibly due to C. difficile diarrhoeal disease were found in a study that included data from 1980 to 1994 from the USA (Frost et al, 1998).…”

Section: Introductionmentioning

confidence: 93%

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Ackermann

Thomalla

Ackermann

et al. 2005

Journal of Medical Microbiology

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Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age .60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values , 0 . 05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.

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“…Since the 1980s the incidence of C. difficile-associated diarrhea (CDAD) has increased dramatically, presumably due to the introduction of new antibiotics prone to select this organism. A study in the United States based on national hospital discharge data from 1980 to 1994 showed an almost 10-fold increase of age-adjusted death rates due to "non-classical diarrhea pathogens" apparently dominated by C. difficile (19). In Sweden, about 50 cases of CDAD per 100,000 inhabitants were diagnosed in 1995, outnumbering all other etiologically diagnosed domestic cases of diarrhea taken together (27).…”

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Molecular Epidemiology of Hospital-Associated and Community-Acquired Clostridium difficile Infection in a Swedish County

Norén¹,

Åkerlund

Bäck³

et al. 2004

J Clin Microbiol

149

121

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All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P ‫؍‬ 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

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Increasing Hospitalization and Death Possibly Due toClostridium difficileDiarrheal Disease

Cited by 38 publications

References 10 publications

Clostridium difficile: How Much do Hospital Staff Know About it?

Clostridium difficile: How Much do Hospital Staff Know About it?

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Molecular Epidemiology of Hospital-Associated and Community-Acquired Clostridium difficile Infection in a Swedish County

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