Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study (original) (raw)
Infection Control and Hospital Epidemiology, 2009
[i.e. diagnosed > 48 hours after admission, healthcare-onset CDI (HO/CDI)] versus expanded definitions, including both HO/CDI cases and community-onset CDI cases diagnosed ≤ 48 hours from admission who were hospitalized in the previous 30 or 60 days [healthcare facility-associated (HCFA)-30 and HCFA-60]. Determine if differences exist between patients with CDI onset in the community versus healthcare setting.
Clinical Infectious Diseases, 2009
Background. Clostridium difficile infection (CDI) is the most frequent cause of health care-associated infectious diarrhea in industrialized countries. The only previous report describing the incidence of health care-associated CDI (HA CDI) in Canada was conducted in 1997 by the Canadian Nosocomial Infection Surveillance Program. We reexamined the incidence of HA CDI with an emphasis on patient outcomes. Methods. A prospective surveillance was conducted from 1 November 2004 through 30 April 2005. Basic demographic data were collected, including age, sex, type of patient ward where the patient was hospitalized on the day HA CDI was identified, and patient comorbidities. Data regarding severe outcome were collected 30 days after the diagnosis of HA CDI; severe outcome was defined as an admission to the intensive care unit because of complications of CDI, colectomy due to CDI, and/or death attributable to CDI. Results. A total of 1430 adults with HA CDI were identified in 29 hospitals during the 6-month surveillance period. The overall incidence rate of HA CDI for adult patients admitted to these hospitals was 4.6 cases per 1000 patient admissions and 65 per 100,000 patient-days. At 30 days after onset of HA CDI, 233 patients (16.3%) had died from all causes; 31 deaths (2.2%) were a direct result of CDI, and 51 deaths (3.6%) were indirectly related to CDI, for a total attributable mortality rate of 5.7%. Conclusions. The rates are remarkably similar to those found in our previous study; although we found wide variations in HA CDI among the participating hospitals. However, the attributable mortality increased almost 4fold (5.7% vs. 1.5%;). P ! .001 Clostridium difficile infection (CDI) is the most frequent cause of health care-associated infectious diarrhea in industrialized countries [1-3] and affects 1300,000 hos
Infection control and hospital epidemiology, 2016
BACKGROUND Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS. OBJECTIVE To describe the relationship between hospital CDI incidence and the LOS of patients without CDI. DESIGN Retrospective cohort analysis. METHODS We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age). SETTING Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009-2011. PATIENTS The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals. RESULTS Inpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with...
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, 2016
Clostridium difficile infection (CDI) remains poorly controlled in many European countries, of which several have not yet implemented national CDI surveillance. In 2013, experts from the European CDI Surveillance Network project and from the European Centre for Disease Prevention and Control developed a protocol with three options of CDI surveillance for acute care hospitals: a 'minimal' option (aggregated hospital data), a 'light' option (including patient data for CDI cases) and an 'enhanced' option (including microbiological data on the first 10 CDI episodes per hospital). A total of 37 hospitals in 14 European countries tested these options for a three-month period (between 13 May and 1 November 2013). All 37 hospitals successfully completed the minimal surveillance option (for 1,152 patients). Clinical data were submitted for 94% (1,078/1,152) of the patients in the light option; information on CDI origin and outcome was complete for 94% (1,016/1,078) an...
Clostridium difficile presence in Spanish and Belgian hospitals
Microbial Pathogenesis, 2016
Clostridium difficile is recognised worldwide as the main cause of infectious bacterial antibioticassociated diarrhoea in hospitals and other healthcare settings. The aim of this study was to first survey C. difficile prevalence during the summer of 2014 at the Central University Hospital of Asturias (Spain). By typing the isolates obtained, it was then possible to compare the ribotype distribution at the Spanish hospital with results from the St Luc University Hospital in Belgium over the same period. The prevalence of positive cases reported in Spain and Belgium was 12.3% and 9.3% respectively. The main PCR-ribotypes previously described in Europe were found in both hospitals, including 078, 014, 012, 020 and 002. In the Spanish hospital, most of the C. difficile-positive samples were referred from oncology, acute care and general medicine services. In the Belgian hospital the majority of positive samples were referred from the paediatric service. However, a high percentage of isolates from this service were nontoxigenic. This study finds that the presence and detection of C. difficile in paediatric and oncology services requires further investigation.
Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update
Infection Control and Hospital Epidemiology, 2014
deletions and carries binary toxin), has been reported to have a higher 14-day mortality in the United Kingdom than BI/NAP1/027. In the United Kingdom, the BI/ NAP1/027 strain is no longer the predominant strain, and it occurs less frequently in continental Europe. In the United States, the prevalence of the BI/NAP1/027 strain averages approximately 25%-35% of CDI cases but ranges from 28% to 85% in adults. II. Outcomes associated with CDI CDI is associated with increased length of hospital stay, costs, morbidity, and mortality in adult and pediatric patients. A. CDI increases hospital length of stay by 2.8 to 5.5 days. 28 B. Attributable costs of inpatient CDI in 2008 dollars have been estimated to be 3,006−3,006-3,006−15,397 per episode. US hospital costs for CDI management have been estimated to be $1.0-4.9 billion per year. Costs of CDI in the outpatient and non-acute care settings have not been assessed. C. Patients with CDI were almost twice as likely to be discharged to a long-term care facility than propensity score-matched controls. 27 D. The attributable mortality of CDI is estimated to be 5%-10%, leading to an estimated 14,000-20,000 deaths attributable to CDI in the United States each year. 14,29 III. Changing risk factors and possible decrease in CDI treatment response rates A. For the past 10 years, fluoroquinolones, previously infrequently associated with CDI, have been found to be one of the primary precipitating antimicrobials in recent studies. 19,31 1. Virtually every antibiotic has been associated with CDI. Cephalosporins, ampicillin, and clindamycin remain important predisposing antibiotics. 15 B. Gastric acid suppression has been recognized as a risk factor for CDI in some studies. 15 1. Some studies suggest that the association between gastric acid suppression and CDI is related to other important risk factors, such as severity of illness and age. 31 2. Gastric acid suppression may be an important risk factor for CDI outside healthcare facilities. 32 C. Several studies suggest that rates of response to treatment of CDI with metronidazole are declining, including a randomized, prospective, blinded, severity-stratified study that demonstrated statistically superior rates of response to vancomycin for severe disease but not for mild disease compared with metronidazole. section 2: background-strategies to detect cdi I. Surveillance definitions Definitions for CDI surveillance in the United States and Europe have been published.
Curēus, 2024
Background Clostridioides difficile infection (CDI) represents a significant healthcare challenge associated with antibiotic use and healthcare settings. While healthcare facility-onset CDI (HO-CDI) rates have been extensively studied, the incidence and risk factors of CDI in various settings, including the community, require further investigation. Aim This study aims to examine the incidence rates of CDI in a major governmental hospital in Bahrain, identify risk factors for CDI, and assess the effectiveness of infection control measures. Method We conducted a retrospective study at the Salmaniya Medical Complex (SMC), analyzing all confirmed cases of CDI over a 30-month period from January 2021 to June 2023. CDI cases were screened using glutamine dehydrogenase antigen detection and confirmed using molecular assays like polymerase chain reaction and/or toxin assays for confirmation. The study categorized CDI cases based on their onset (hospital or community) and explored associated risk factors, including antibiotic use, proton pump inhibitor (PPI) therapy, and patient demographics. Infection control practices were also evaluated for their role in managing CDI. Results About 57 new CDI cases were identified during the study period, with a HO-CDI incidence rate of 0.5 per 10,000 patient days. While HO-CDI rates remained stable, community-onset (CO)-CDI cases increased. The median patient age was 61.8 years, without notable differences between genders. Key risk factors for CDI were antimicrobial therapy, use of acid-reducing agents, age, and underlying comorbidities. The mortality rate stood at 35.1%. The ATLAS score (i.e., age, treatment with antibiotics, leukocyte count, albumin level, and serum creatinine) was a reliable predictor of mortality. Critical care admission and low albumin levels emerged as significant independent risk factors for mortality. Conclusions The study demonstrates a low incidence rate of HO-CDI at SMC, attributed to effective infection control and antibiotic stewardship programs. The overall CDI rate increased during the study period, driven by a rise in CO cases; further investigating the risk factors among this category in our study revealed that most patients were exposed to antibiotic therapy within the past three months of their CDI diagnosis. The rise in CO-CDI cases underscores the need for broader community-based interventions and awareness regarding antibiotic and PPI use.
Epidemiology of Clostridium difficile infection: results of a hospital-based study in Krakow, Poland
Epidemiology and infection, 2015
Over the past two decades Clostridium difficile infection (CDI) has appeared as a major public health threat. We performed a retrospective study based on the records of patients hospitalized for CDI at the University Hospital in Krakow, Poland, between 2008 and 2014. In the study period, CDI occurred in 1009 individuals. There were 790 (78%) individuals who developed infection only once, whereas 219 (22%) developed infection more than once. The percentage of deaths within 14 days of CDI confirmation was 2·4%, with a mean age of 74·2 ± 15·9 years. Crude mortality was 12·9% in medical wards, 5·6% for surgical wards and 27·7% in the ICU setting. The time span between diagnosis and death was 5·1 days on average. Between 2008 and 2012 a 6·5-fold increase of CDI frequency with a posterior stabilization and even reduction in 2013 and 2014 was observed. According to the data analysed, 2/3 patients in our population developed CDI during their hospitalization even though they were admitted fo...
Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection
Antimicrobial Agents and Chemotherapy, 2020
Background: Clostridioides difficile infection (CDI) is a healthcare-associated infection associated with significant morbidity and cost with highly variable risk across populations. More effective, risk-based prevention strategies are needed. Here we investigate risk factors for hospital-associated CDI in a large integrated health system. Methods: In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (1) hospital-onset and (2) healthcare-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including specific agents, using multivariable logistic regression. Results: 2356 cases of CDI among 506,068 admissions were identified (incidence 46.6 per 10,000). Prior antibiotic use was the dominant risk factor – for every antibiotic day of therapy prior to the index admission, odds of subsequent CDI increased by 12.8% (95% CI 12.2-13.4%, p<0.0001). Thi...