The prevalence and nosocomial acquisition of <i>Clostridium difficile</i> in elderly hospitalized patients

Rudensky, Bernard; Rosner, Stuart; Sonnenblick, M; Dijk, Y. van; Shapira, E.; Isaacsohn, M.

doi:10.1136/pgmj.69.807.45

Cited by 42 publications

(24 citation statements)

References 13 publications

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“…CDAD is reportedly more common among older individuals (6,10,20,21,(24)(25)(26). In this study, 176 patients (67%) were older than age 65 years; this high proportion of older patients may reflect that there are larger numbers of elderly hospitalized patients or that older individuals are more susceptible to C difficile infections.…”

Section: Discussionmentioning

confidence: 84%

“…LOS in hospital has been found to be significant in determining whether patients become colonized, and subsequently symptomatic, with C difficile (20). People with a longer LOS are generally older, sicker and on antibiotics, which may render them more susceptible to acquiring C difficile colonization or infection (15).…”

Section: Discussionmentioning

confidence: 99%

“…Because elderly people and those exposed to large amounts of antibiotics have a higher risk of acquiring CDAD, they are commonly surveyed (15,20,21). Specific wards (eg, medical and surgical) where the rates of CDAD are higher are also more frequently studied (2,6,22,23).…”

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confidence: 99%

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N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

Hyland

Ofner-Agostini²,

Miller

et al. 2001

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND:A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance ofClostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE:To establish national prevalence rates of N-CDAD.METHODS:For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for eitherC difficiletoxin orC difficilebacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS:Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

Hyland

Ofner-Agostini²,

Miller

et al. 2001

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…We have, in the recent past, encountered a relatively high proportion of asymptomatic carriers of C. difficile in our hospitals, and the interpretation of positive cultures was equivocal. C. difficile or its toxin has been reported in one study from nearby Saudi Arabia (Akhter et al, 1994), in Turkey (Soyletir et al, 1996) and in a few reports from Israel (Rudensky et al, 1993;Rivlin et al, 1998;Boaz et al, 2000). However, this is the first report on PCR ribotyping of C. difficile strains isolated from symptomatic and asymptomatic patients in the Middle East.…”

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confidence: 99%

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

Rotimi

Jamal

Mokaddas

et al. 2003

Journal of Medical Microbiology

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Ninety-five isolates of Clostridium difficile from symptomatic and asymptomatic patients and 18 from their environment in the intensive-therapy units (ITUs) of four teaching hospitals in Kuwait were typed by PCR amplification of rRNA intergenic spacer regions (PCR ribotyping). A total of 32 different ribotypes was detected among the clinical isolates. The predominant ribotypes from the clinical isolates were types 097 and 078, which accounted for $ 40 % of all isolates in the ITUs in Kuwait. Ribotypes 097 (toxigenic), 078 (toxigenic) and 039 (non-toxigenic) were three distinct clones that were circulating in all four hospitals. Ribotypes 097, 078 and 076 (i.e. 50 % of isolates from symptomatic patients) were the predominant isolates associated with C. difficile-associated disease (CDAD). The environmental isolates belonged to a diverse range of ribotypes, with no particular types common to all the hospitals. Ribotype 078 was found only in the patient environment in Mubarak hospital, while ribotype 097 was restricted to Amiri hospital. The hospital environment occupied by symptomatic as well as symptom-free patients was contaminated with C. difficile. Eight new strains that did not match any in the PCR ribotype library established at the PHLS Anaerobe Reference Unit, Cardiff, UK, were assigned ribotypes 105, 125, 128, 129, 131, 134, 140 and 141. These findings show that the isolates associated with CDAD in Kuwait are different from those found in the UK and some other European countries. INTRODUCTIONClostridium difficile is an anaerobic, Gram-positive, sporeforming bacillus. It is often associated with a spectrum of diseases, referred as C. difficile-associated disease (CDAD), which manifest as self-limiting antibiotic-associated diarrhoea (AAD), antibiotic-associated colitis (AAC) and pseudomembranous colitis (PMC) with toxic megacolon and possible gut perforation. Rarely, it can present as extraintestinal infections, such as arthritis, osteomyelitis, softtissue infection and bacteraemia (Levett, 1986). CDAD is an important clinical problem because it is often acquired by hospitalized patients, and C. difficile is associated with outbreaks of diarrhoea and colitis in hospitalized adults receiving antibiotics (Bartlett et al., 1978;Djuretic et al., 1999).In spite of major efforts to control the spread of CDAD in hospitals and nursing homes, this organism has remained a major problem worldwide, and it continues to be responsible for endemic and epidemic nosocomial diarrhoea (McFarland et al., 1989; Johnson et al., 1990;Barbut et al., 1996). C. difficile, or its toxins, has been identified in 8-10 % of cases of nosocomial diarrhoea, while other common bacterial enteric pathogens, Salmonella, Shigella and Campylobacter spp., are rarely isolated (Fan et al., 1993;Rohner et al., 1997).It appears that the most important sources of C. difficile in a hospital setting are symptomatic patients and asymptomatic carriers who are the main reservoirs of C. difficile in the hospital. The environment of these patients is also an...

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“…The analysis of epidemiological studies showed that there was a difference in the rate of carriership depending on the patient type. Asymptomatic carriership was found in 7% of patients hospitalized for a long time in a general ward [13], 14% of elderly patients hospitalized in the intensive care unit [14] and 20% of elderly patients hospitalized for chronic illnesses and in need of other care and assistance or for the maintenance of vital functions [15]. Some studies indicated that among hospitalized patients older than 65 years, the rate of carriership was even up to 30% [4,5].…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic carriers of clostridium difficile in serbian population

Stojanović¹,

Stojanović

Kocić³

et al. 2012

Open Medicine

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AbstractThe aim of the research was to determine the intestinal carriers of C. difficile in different human population groups in Serbia. The research enrolled 877 persons with formed stools: (newborn children in maternity hospitals for up to two weeks old) (23), group A; children aged from two weeks to two years (121), group B; children aged two to 10 years (54), group C, healthy individuals aged 10 and over (516), group D; patients hospitalized for at least 48 hours (100), group E; staff of the Clinical Center in Nis, Serbia, (63), group F. The toxins A and B of C. difficile were detected by ELISA-ridascreen Clostridium difficile Toxin A/B (R — Biopharm AG, Darmstadt, Germany). The toxin A of C. difficile was detected using ColorPAC Toxin A test (BectonDickinson, New Jersey, USA). Out of the total number of persons (877), the carriers of certain types of toxin-producing strains of C. difficile were distributed as: 6.04% (A−/B−), 1.83% (A+/B+) and 0.11% (A−/B+). In most groups (5/6), the dominance of non-toxigenic (A−/B−) isolates was established, with the rate of carriers 1.75 – 30.43% depending on the group. Toxigenic isolates were prevalent only in the group F in relation to non — toxigenic (7.94% versus 4.76% of persons). In other groups, the carriers of toxigenic strains ranged from 0.00 – 17.45%. The presence of asymptomatic intestinal carriers of C. difficile in the human population, indicate the possible reservoirs and sources of infection.

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The prevalence and nosocomial acquisition of Clostridium difficile in elderly hospitalized patients

Cited by 42 publications

References 13 publications

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

Asymptomatic carriers of clostridium difficile in serbian population

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