The risk of Clostridium difficile associated diarrhea in nasogastric tube insertion: A systematic review and meta-analysis

Wijarnpreecha, Karn; Sornprom, Suthanya; Phatharacharukul, Parkpoom; Cheungpasitporn, Wisit; Nakkala, Kiran

doi:10.1016/j.dld.2016.01.012

Cited by 13 publications

(6 citation statements)

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“…Most of the risk factors frequently reported in several studies for the development CDI include, number and type of antibiotics, patients older than 65 years [ 32 , 33 ], length of stay (LOS) at the hospital [ 34 , 35 ], nasogastric tube insertion [ 36 ], and various comorbidities or preexisting conditions [ 23 , 34 , 37 , 38 ]; nonetheless, in this study, these variables did not show significant associations.…”

Section: Discussionmentioning

confidence: 66%

Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia

et al. 2017

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In Colombia, the epidemiology and circulating genotypes of Clostridium difficile have not yet been described. Therefore, we molecularly characterized clinical isolates of C.difficile from patients with suspicion of C.difficile infection (CDI) in three tertiary care hospitals. C.difficile was isolated from stool samples by culture, the presence of A/B toxins were detected by enzyme immunoassay, cytotoxicity was tested by cell culture and the antimicrobial susceptibility determined. After DNA extraction, tcdA, tcdB and binary toxin (CDTa/CDTb) genes were detected by PCR, and PCR-ribotyping performed. From a total of 913 stool samples collected during 2013–2014, 775 were included in the study. The frequency of A/B toxins-positive samples was 9.7% (75/775). A total of 143 isolates of C.difficile were recovered from culture, 110 (76.9%) produced cytotoxic effect in cell culture, 100 (69.9%) were tcdA+/tcdB+, 11 (7.7%) tcdA-/tcdB+, 32 (22.4%) tcdA-/tcdB- and 25 (17.5%) CDTa+/CDTb+. From 37 ribotypes identified, ribotypes 591 (20%), 106 (9%) and 002 (7.9%) were the most prevalent; only one isolate corresponded to ribotype 027, four to ribotype 078 and four were new ribotypes (794,795, 804,805). All isolates were susceptible to vancomycin and metronidazole, while 85% and 7.7% were resistant to clindamycin and moxifloxacin, respectively. By multivariate analysis, significant risk factors associated to CDI were, staying in orthopedic service, exposure to third-generation cephalosporins and staying in an ICU before CDI symptoms; moreover, steroids showed to be a protector factor. These results revealed new C. difficile ribotypes and a high diversity profile circulating in Colombia different from those reported in America and European countries.

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Section: Discussionmentioning

confidence: 66%

Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia

et al. 2017

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“…This was not found to be a significant risk factor (12.50% versus 20.91% P = 1.00). In the literature, current evidence regarding the effect of NGT insertion on the development of CDI is inconclusive, with a number of studies have demonstrated it as a potential risk factor, [12][13][14] other studies failing to identify a significant association, 15,16 and one study identifying it as a protective factor for the development of CDI. 17 Additionally, one patient who developed CDI, had been on preoperative steroids for polymyalgia rheumatica.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Clostridioides difficile in patients post loop ileostomy reversal in an Australian tertiary hospital: a retrospective study

Jordan

Hui

Doudle

et al. 2021

ANZ Journal of Surgery

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Introduction The purpose of a loop ileostomy is to temporarily divert faeces away from a distal anastomosis, to reduce the consequences of anastomotic leak. This ultimately requires a second procedure to restore bowel continuity, which confers risk of complications including the development of Clostridioides difficile infection (CDI). It is hypothesized that patients who undergo loop ileostomy reversal are at increased risk of CDI when compared with other patients undergoing elective colorectal surgical procedures, and that these patients also experience an increased length of stay (LOS). Methods A retrospective cohort study was performed on all patients who underwent loop ileostomy reversal at the Gold Coast Hospital and Health Service between 1 January 2012 and 31 December 2019. Results Two hundred and twenty‐eight patients were identified. Eight tested positive for CDI on faecal PCR (3.51%), a higher incidence than that in patients who underwent an elective colorectal surgical procedure during the same period (0.83%) (RR = 4.23). Additionally, median LOS for ileostomy reversal patients was significantly increased in those who also had CDI when compared with those without CDI (11 versus 4 days; P = 0.0003). Conclusion The study confirmed that the incidence of CDI was higher in those who underwent ileostomy reversal when compared with an otherwise comparable hospital population (elective colorectal surgery patients). Additionally, those patients who underwent ileostomy reversal and had CDI experienced an increased LOS which translates to increased cost to the healthcare system. Further investigation into pre‐operative screening and prophylactic antibiotics should be considered as a measure to mitigate this post‐operative complication.

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“…Contrario a lo hallado en la literatura científica (13,33), el uso de sondas de nutrición entérica se comportó como un factor protector en este estudio. Bliss, et al (13), encontraron que su uso, especialmente de sondas colocadas más allá del píloro, se relacionaba con un mayor riesgo de enfermedad asociada a C. difficile (20 % Vs. 8 %).…”

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Clinical and demographic profile and risk factors for Clostridium difficile infection

Carvajal¹,

Pacheco²,

Jaimes³

2017

biomedica

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Contribución de los autores:Todos los autores participaron en igual medida en todos los aspectos del estudio y la redacción del manuscrito. Introducción. La enfermedad asociada a Clostridium difficile es la principal causa de diarrea infecciosa adquirida en el hospital; su creciente incidencia, las menores tasas de respuesta al tratamiento inicial y la mayor tasa de recaídas han incrementado la carga de la enfermedad. Objetivo. Determinar las características clínicas de los pacientes hospitalizados con enfermedad asociada a C. difficile. Materiales y métodos. Se hizo un estudio de casos anidado en una cohorte. Se revisaron las historias clínicas de pacientes con diarrea iniciada durante su hospitalización a quienes se les había practicado la prueba de detección de la toxina A-B de C. difficile, entre febrero de 2010 y febrero de 2012. Se definió como caso al paciente hospitalizado con diarrea y prueba de Enzyme Linked Fluorescent Assay (ELFA) positiva para la toxina y, como control, a aquel con resultado negativo para la toxina. Se recolectaron los datos demográficos y clínicos, así como la información sobre los factores asociados, la estancia hospitalaria, el tratamiento y las complicaciones. Perfil clínico y demográfico y factores de riesgo frente a la infección por Clostridium difficileResultados. Durante el periodo de seguimiento se recolectaron datos de 123 pacientes, de los cuales 30 fueron positivos para la toxina. La edad media en la población de estudio fue de 49 años y el 60 % correspondía a hombres. Los síntomas predominantes fueron el dolor abdominal (35 %) y la fiebre (34 %). Las principales complicaciones fueron la alteración electrolítica y la sepsis grave asociada con disfunción renal. La mortalidad total fue de 13 % y los factores independientes asociados con la aparición de la infección fueron el uso de inhibidores de la bomba de protones y la cirugía gastrointestinal previa. Conclusiones. El uso de inhibidores de la bomba de protonesy la cirugía gastrointestinal previa fueron factores asociados con la infección por C. difficile. Clinical and demographic profile and risk factors for Clostridium difficile infectionIntroduction: Clostridium difficile infection is the leading cause of nosocomial infectious diarrhea. The increasing incidence added to a lower rate of response to the initial treatment and higher rates of relapse has generated a higher burden of the disease. Objective: To determine the clinical characteristics of hospitalized patients with C. difficile infection. Materials and methods:We made a nested case-cohort study. We reviewed medical records of the patients with nosocomial diarrhea for whom an assay for toxin A-B of C. difficile had been requested from February, 2010, to February, 2012. We defined case as a patient with diarrhea and a positive assay for the toxin, and control as those patients with a negative assay for the toxin. We collected data on demographic and clinical characteristics, risk factors, hospital length of stay, treatment, and complications. Results: We collec...

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The risk of Clostridium difficile associated diarrhea in nasogastric tube insertion: A systematic review and meta-analysis

Cited by 13 publications

References 25 publications

Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia

Molecular, microbiological and clinical characterization of Clostridium difficile isolates from tertiary care hospitals in Colombia

Incidence of Clostridioides difficile in patients post loop ileostomy reversal in an Australian tertiary hospital: a retrospective study

Clinical and demographic profile and risk factors for Clostridium difficile infection

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