Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting (original) (raw)
Related papers
2018
INTRODUCTION The incidence and severity of healthcare-associated Clostridium difficile infections (HA-CDI) have been increasing since the emergence and the epidemic spread of the invasive strain BI/ NAP1/027 (Khanna & Pardi, 2010; Khanna et al, 2013; Barbut & Petit, 2001; Freeman et al., 2010). Concern is also growing that Clostridium difficile (C. difficile), historically considered a healthcare-associated infection, is increasingly a cause of diarrhea in the community, causing community-associated Clostridium difficile infections (CA-CDI) (Khanna & Pardi, 2010; Khanna et al., 2012). Although many studies have explored Epidemiology of patients hospitalized with Clostridium difficile infection: A comparative analysis of community-associated and healthcare-associated Clostridium difficile infections
Diagnosis of Clostridium difficile infection in patients with hospital-acquired diarrhea
2018
Clostridium difficile infection (CDI) is a rapidly emerging infection that may have devastating consequences. Prompt and accurate diagnosis is crucial for management and control. The aim of this study was to determine the incidence of C. difficile associated diarrhea among hospitalized patients, and to compare different diagnostic laboratory methods for detection of toxin producing strains in clinical specimens. The study was conducted at a university hospital in Cairo during the period from May 2013 till June 2015. Subjects were under antibiotic therapy and presented with hospital-acquired diarrhea. Four hundred and sixty-five stool specimens were processed by different microbiological methods. C. difficile was recovered in culture in 51 of stool specimens. Of these, 86.3% to 98% were positive for toxin production by 2 different methods. This study showed that antibiotic intake is the major risk factor for development of hospital-acquired diarrhea. We evaluated different microbiological methods for diagnosis of C. difficile. We recommend the use of toxigenic culture as a gold standard for microbiological diagnosis of C. difficile.
Indian Journal of Gastroenterology, 2011
The spectrum of Clostridium difficile-associated diarrhea (CDAD) is changing. Apart from antibiotic use, other risk factors such as use of proton pump inhibitors (PPI) and immunosuppressive agents, intensive care unit (ICU) stay and inflammatory bowel disease are being recognized. We retrospectively analyzed data on patients whose stool samples were tested for C. difficile toxin (CDT) by enzyme linked immunosorbent assay between June 2006 and May 2008. Demographic and clinical data, and risk factors (antibiotic use, underlying malignancy, chemotherapy, use of PPI, ICU stay) were noted. The details of treatment for CDAD, response, complication and follow up were recorded. Patients whose stool samples were CDT-positive were grouped as study subjects and those with negative stool samples were included in the control group. Of the 99 patients (mean age 46.7 years; 58 men) whose stool samples were tested during this period, 17 (17%) were positive for CDT. As compared with control subjects (n=82), study subjects were more likely to have fever, prolonged ICU stay, underlying malignancy, and exposure to immunosuppressive and chemotherapeutic agents. On multivariate analysis, exposure to immunosuppressive agents was the only risk factor associated with CDAD. Fifteen patients were treated with metronidazole and two with vancomycin. Two patients did not respond to metronidazole but responded to vancomycin. No patient developed any complication. The prevalence of C. difficile toxin in diarrheal stools sent for C. difficile toxin testing was 17%. Exposure to immunosuppressive agents was a risk factor for the infection. Metronidazole was effective in a majority of patients.
American Journal of Infection Control, 2005
Background: Clostridium difficile is a toxin-producing bacterium that is responsible for toxicity to the colonic mucosa, causing inflammation, necrosis, and, in some extreme cases, intestinal dilation and perforation. C difficile-associated diarrhea (CDAD) occurs when patients have a reduction in their natural gastrointestinal flora that allows for the proliferation of and toxin production by C difficile. Methods: Using a multicenter, prospective observational case control study, we assessed and quantified risk factors associated with the development of diarrhea caused by Clostridium difficile, with particular attention to antibiotic use. All hospitalized patients with diarrhea requiring a C difficile toxin test as part of their routine clinical workup were considered for study inclusion. Patients with a negative specimen (controls) were considered for enrollment if matched (by age, sex, length of stay, and institution) to a case. Variables associated with CDAD were identified using univariate analysis. Significant factors were then entered into multivariate logistic regression analysis to identify independent factors. Results: There were no significant differences in antibiotic use between cases and controls. Patient severity, classified by Horn's Index, was significantly different between cases and controls (P 5 .0022). No other significant variables were identified. Conclusion: The severity of illness of the cases was classified as more severe than the controls, but no significant differences in antibiotic use were identified between the groups. The negative C difficile toxin studies on the well-matched control patients indicate a different etiology of diarrhea (such as antibiotic-associated diarrhea), which may have developed in the presence of similar antibiotic use as the cases.
Gastroenterology Research and Practice, 2015
Background. The epidemiology ofClostridium difficileinfection has changed over time. Therefore, it is essential to monitor the characteristics of patients at risk of infection and factors associated with poor prognosis.Objective. To evaluate factors associated withC. difficileinfection and with poor prognosis in those with documentedC. difficilecolitis.Methods. A retrospective case-control study of 75 patients with documentedC. difficilecolitis and 75 controls with hospital-acquired diarrhea of other causes. Stepwise multiple logistic regression was used to identify factors associated withC. difficileinfection among patients with hospital-acquired diarrhea.Results. Previous antibiotic treatment (odds ratio (OR), 13.3; 95% confidence interval (CI), 1.40–126.90), abdominal distension (OR, 3.85; 95% CI, 1.35–10.98), and fecal leukocytes (OR, 8.79; 95% CI, 1.41–54.61) are considered as predictors ofC. difficilecolitis; anorexia was negatively associated withC. difficileinfection (OR, 0....
Current Trends in the Epidemiology and Outcomes of Clostridium difficile Infection
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015
Clostridium difficile is the most frequently identified cause of nosocomial diarrhea and has been associated with epidemics of diarrhea in hospitals and long-term care facilities. The continued increase in C. difficile infection (CDI) suggests that it has surpassed other pathogens in causing healthcare-associated infections. The Centers for Disease Control and Prevention recently identified CDI as an "urgent threat" in its recent report on antibiotic resistance threats in the United States, highlighting the need for urgent and aggressive action to prevent this infection. The impact of antibiotics as a risk factor for new-onset CDI is well established; however, recognizing classes of antibiotics with the highest risks and reducing unnecessary antibiotic use are important strategies for prevention of CDI and subsequent recurrence. In addition, the recognition of the community as an important setting for onset of CDI presents a challenge and is an area for future research.
The Indian journal of medical research, 2008
Frequent use of broad spectrum antibiotics in hospitalized patients has increased the incidence of Clostridium difficile diarrhoea in recent years. In our tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999. A retrospective study was carried out to determine the frequency of C. difficile associated diarrhoea (CdAD) in our hospital, and to assess the effect of awareness among the hospital personnel and control measures taken to present C. difficile infection following the previous report. A retrospective chart review of all suspected cases of CdAD diagnosed at the hospital from January 2001 to December 2005 was done. Clinical specimens comprised 524 stool samples. All the samples were analyzed for C. difficile using culture and ELISA for toxin A and B. Attempts were made to type isolates using antibiogram, SDS-PAGE, gas liquid chromatography (GLC), PCR for toxin A and B gene fragments and restriction fragment le...
2017
Medical Center evaluated the Biofire FilmArray Gastrointestinal Panel, a multiplex PCR assay to conventional stool culture. The FilmArray can detect both toxin A (tcdA) and toxin B genes (tcdB) in Clostridium difficile. C. difficile is not detected by conventional stool culture. Instead, both laboratories use the Cepheid GeneXpert C. diffcile assay to rapidly detect the toxin B gene (tcdB). These two different test methods and the testing requirements provided an opportunity to compare clinical features of patients whom CDI was detected by targeted testing to those whom CDI was an unexpected finding detected by the multiplex PCR assay. A retrospective observational cohort study was performed on one-hundred forty cases of diagnosed CDI. A comparison of risk factors, clinical presentation, and responses to CDI-specific therapy was done between inpatients and outpatient cases. Analysis of the results showed that inpatients and outpatients were considerably similar in all those categories. There is a significant proportion of the CDI burden, with potential of cases overlooked, in the outpatient setting.