Detection Of Clostridium Difficile Research Articles

Detection of Clostridium difficile among diarrheic children using cultural and polymerase chain reaction technique

Introduction: Clostridium difficile is the most common cause of antibiotic-associated diarrhea and colitis. Several methods are available for the detection of C. difficile in stool samples. This study aimed to use glutamate dehydrogenase (GDH), toxin detection, culture and polymerase chain reaction (PCR) techniques for the diagnosis of this pathogen. Methodology: A total of 300 stool samples were collected from children with hospital acquired diarrhea (HA-D), community acquired diarrhea (CA-D), and hospitalized non-diarrheic children as control with ages ranging from 6 months to 6 years (mean 3.7 ± 1.7). Each stool sample was divided into two parts; one part was tested for the enzyme GDH, toxin A and B and then cultured on selective media; and the other part for direct DNA extraction. Results: From a total of 300 stool samples, 9 (3.0%) were positive for C. difficile by the PCR technique, 7 (7%) samples of which were from HA-D cases and 2 (2.0%) from CA-D cases; the control group samples were negative. The enzyme GDH was detected in 12 (12%) samples and toxins A and B in 8 (8%) samples from HA-D cases compared to 5 (5%) and 2 (2%), respectively from CA-D cases. Both GDH and the toxins were negative in control samples. Only 19 (19.0%) samples from HA-D cases gave suspected growth and all of these were negative by PCR. Conclusions: Based on the results of this study, we conclude that the PCR technique is the only reliable method for the diagnosis of this pathogen.

A Comparison of Pathogen Detection and Risk Factors among Symptomatic Children with Gastroenteritis Compared with Asymptomatic Children in the Post-rotavirus Vaccine Era

To describe demographics, pathogen distribution/seasonality, and risk factors in children seeking care for acute gastroenteritis (AGE) at a midwestern US emergency department during 5 postrotavirus vaccine years (2011-2016), and further, to compare the same data with matched healthy controls (HC). AGE and HC participants <11years old enrolled in the New Vaccine Surveillance Network study between December 2011 to June 2016 were included. AGE was defined as ≥3 diarrhea episodes or ≥1 vomiting episode. Each HC's age was similar to an AGE participant's age. Pathogens were analyzed for seasonality effects. Participant risk factors for AGE illness and pathogen detections were compared between HC and a matched subset of AGE cases. One or more organisms was detected in 1159 of 2503 children (46.3%) with AGE compared with 99 of 537 HC (17.3%). Norovirus was detected most frequently among AGE (n=568 [22.7%]) and second-most frequently in HC (n=39 [6.8%]). Rotavirus was the second most frequently detected pathogen among AGE (n=196 [7.8%]). Children with AGE were significantly more likely to have reported a sick contact compared with HC, both outside the home (15.6% vs 1.4%; P<.001) and inside the home (18.6% vs 2.1%; P<.001). Daycare attendance was higher among children with AGE (41.4%) compared with HC (29.5%; P<.001). The Clostridium difficile detection rate was slightly higher among HC (7.0%) than AGE (5.3%). Norovirus was the most prevalent pathogen among children with AGE. Norovirus was detected in some HC, suggesting potential asymptomatic shedding among HC. The proportion of AGE participants with a sick contact was approximately 10 times greater than that of HC.

Aetiology of hospital-acquired diarrhoea in under-five children from an urban hospital in East Delhi, India.

Majority of the studies of hospital-acquired diarrhoea conducted in Western countries have focused on the detection of Clostridium difficile in stool samples. Limited Asian and Indian literature is available on hospital-acquired diarrhoea. This study was aimed to describe the aetiological profile for hospital-acquired diarrhoea in children aged below five years. One hundred children aged one month to five years who developed diarrhoea (≥3 loose stools for >12 h) after hospitalization for at least 72 h were enrolled. Children who were prescribed purgatives or undergoing procedures such as enema and endoscopy or those with underlying chronic gastrointestinal disorders such as celiac disease and inflammatory bowel disease were excluded from the study. Stool samples from the enrolled children were subjected to routine microscopic examination, modified Ziel-Nielson (ZN) staining for Cryptosporidium and culture for various enteropathogens. Multiplex PCR was used to identify the strains of diarrhoeagenic Escherichia coli. Rotavirus detection was done using rapid antigen kit. Toxins (A and B) of C. difficile were detected using enzyme immunoassay. Of the 100 samples of hospital-acquired diarrhoea analysed, diarrhoeagenic E. coli (DEC) was found to be the most common organism, detected in 37 per cent of cases (enteropathogenic E. coli-18%, enterotoxigenic E. coli-8%, enteroaggregative E. coli-4% and mixed infections-7%). Cryptosporidium was detected in 10 per cent of cases. Rotavirus was detected in six per cent and C. difficile in four per cent of cases. The findings of this study suggest that the aetiological profile of hospital-acquired diarrhoea appears to be similar to that of community-acquired diarrhoea, with DEC and Cryptosporidium being the most common causes. The efforts for the prevention and management of hospital-acquired diarrhoea should, thus, be directed towards these organisms.

Simple and portable on-site system for nucleic acid-based detection of Clostridium difficile in stool samples using two columns containing microbeads and loop-mediated isothermal amplification.

It is challenging to employ nucleic acid-based diagnostics for the in situ detection of Clostridium difficile from complex fecal samples because essential sample preparation and amplification procedures require various experimental resources. In this study, a simple and effective on-site nucleic acid-based detection system was used to detect C. difficile in stool samples. Two columns containing different microbeads, namely, glass and functionalized graphene oxide-coated microbeads, were designed to remove relatively large impurities by filtration and concentrate bacteria, including C. difficile, from stool samples by adsorption. The bacterial nucleic acids were effectively extracted using a small bead beater. The effectiveness of enzyme inhibitors remaining in the sample was efficiently reduced by the direct buffer developed in this study. This sample preparation kit consisting of two simple columns showed better performance in real-time polymerase chain reaction (PCR) and equivalent performance in loop-mediated isothermal amplification (LAMP) than other sample preparation kits, despite 90% simplification of the process. The amplification-ready samples were introduced into two microtubes containing LAMP pre-mixtures (one each for E. coli as an external positive control and C. difficile) by a simple sample loader, which was operated using a syringe. LAMP, which indicates amplification based on color change, was performed at 65 °C in a small water bath. The limit of detection (L.O.D) and analytical sensitivity/specificity of our simple and effective kit were compared with those of a commercial kit. C. difficile in stool samples could be detected within 1 h with 103 cfu/10 mg using LAMP combined simple on-site detection kit.

Study of diagnostic methods for detection of clostridium difficile by glutamate dehydrogenase and toxin A/B combination for rapid diagnosis of antibiotic associated causes of diarrhea in pediatric age group

Background: Although the reports from India regarding the prevalence of C. difficile in children are scanty, the actual estimated picture of CDI in our country could be more because the detection of C. difficile requires tedious and costly anaerobic techniques. In the present study we aimed to evaluate diagnostic methods for detection of Clostridium difficile by glutamate dehydrogenase and toxin A/B combination for rapid diagnosis of antibiotic associated causes of diarrhea in pediatric age group. Material and Methods: Present study was single-center, descriptive observational cross-sectional study, conducted in pediatric age group patients (&lt; 13years), hospitalized for diarrhea and receiving antibiotics for more than 5 days, underwent detection of GDH and toxin A/ B by rapid kit-based test. Results: Out of 120 cases, majority of the cases were in age group of 7- 9 years (31.67 %) and male to female ratio was 1.93:1. 76.67 % cases had fever; 78.33 % cases developed diarrhea; 42.5 % cases complained of pain in abdomen. 24.16% of the cases were GDH positive, 15.83% males and 8.33% females; 11.66% of the cases were toxin positive, 5.83% males and 5.83% females; 22.5% of the cases were culture positive, 14.16% males and 8.33% females. The toxin positivity rate amongst the GDH positives was 48.27%; 14 cases out of the total 29 cases of GDH positives; 36.84% in males and 70% in females; statistically significant difference between GDH positivity and toxin positivity. The toxin positivity rate amongst the culture positives was 51.85%; 14 cases out of the total 27 cases of culture positives; 41.17% in males and 70% in females; statistically significant difference between culture positivity and toxin positivity. Conclusion: Rapid test provide quick easy and cost effective means of accurately diagnosing CDI. The use of such test to screen both GDH and toxin A/B will allow the laboratory to detect more samples without having to test these specimens to more expensive and time-consuming test like cultures, EIA and PCR.

Cost Consequences for the NHS of Using a Two-Step Testing Method for the Detection of Clostridium difficile with a Point of Care, Polymerase Chain Reaction Test as the First Step.

Clostridium difficile infection (CDI) is a common healthcare-associated infection. Current practice for diagnosing CDI in the Newcastle upon Tyne Hospitals NHS Foundation Trust involves a three-step, laboratory testing strategy using glutamate dehydrogenase (GDH) enzyme immunoassay (EIA), followed by a polymerase chain reaction (PCR) test then a toxin EIA. However, a PCR point of care test (POCT) for the C. difficile tcdB gene for screening suspected CDI cases, may provide a more efficient way of facilitating an equally effective, two-step, testing strategy with a toxin EIA. This study evaluated the cost consequences of changing from the three-step to a two-step testing strategy. A cost-consequences model was developed to compare the costs and consequences of the two strategies. Uncertainties in the model inputs were investigated with one- and two-way sensitivity analysis. The two-step, POCT strategy was estimated to save £283,282 per 1000 hospitalized NHS patients with suspected infectious diarrhea. Sensitivity analysis indicated that the turnaround time for the POCT was the largest driver for cost savings. Providing the POCT has sufficiently high diagnostic accuracy for detecting C. difficile, the two-step, POCT strategy for CDI identification is likely to be cost saving for NHS hospitals with an offsite laboratory.

Insight into an Oxidative DNA-Cleaving DNAzyme: Multiple Cofactors, the Catalytic Core Map and a Highly Efficient Variant.

SummaryAn oxidative DNA-cleaving DNAzyme (PL) employs a double-cofactor model “X/Cu2+” for catalysis. Herein, we verified that reduced nicotinamide adenine dinucleotide (NADH), flavin mononucleotide, cysteine, dithiothreitol, catechol, resorcinol, hydroquinone, phloroglucinol, o-phenylenediamine, 3,3′,5,5'-tetramethylbenzidine, and hydroxylamine acted as cofactor X. According to their structural similarities or fluorescence property, we further confirmed that reduced nicotinamide adenine dinucleotide phosphate (NADPH), 2-mercaptoethanol, dopamine, chlorogenic acid, resveratrol, and 5-carboxyfluorescein also functioned as cofactor X. Superoxide anions might be the commonality behind these cofactors. We subsequently determined the conservative change of individual nucleotides in the catalytic core under four different cofactor X. The nucleotides A4 and C5 are highly conserved, whereas the conservative levels of other nucleotides are dependent on the types of cofactor X. Moreover, we observed that the minor change in the PL's secondary structure affects electrophoretic mobility. Finally, we characterized a highly efficient variant T3G and converted its double-cofactor NADH/Cu2+ to sole-cofactor NADH.

Comparison of Viable Environmental Bacterial Prevalence and Species in Outpatient General Medicine and Pulmonary Patient Units

<h3>Background</h3> Environmental bacteria in outpatient healthcare facilities likely influence patient outcomes and recovery. The diversity and quantity of these bacterial communities are largely unknown. The purpose of this study was to compare viable bacteria found in general medicine (GenM) and pulmonary (PUL) units of an outpatient children's clinic. <h3>Methods</h3> Six locations (4 floor sites, counters, and air ducts) were sampled in rooms in the GenM and PUL units over a 6-month period. Sterile transport swabs were used to sample clinic sites, and then to inoculate selective and differential media for the detection of Clostridium difficile (Cdiff), methicillin-resistant Staphylococcus aureus (MRSA), Lac+ Gram negatives (GN), and Pseudomonas sp. and P. aeruginosa (PS & PSA). <h3>Results</h3> Bacterial presence in GenM and PUL units differed by species and location. GN bacteria were widespread in both units. Bacterial presence was greatest on the floors (GN, 72% to 85% of swabs in GenM and PUL, respectively), while counters had fewer positive swabs (GN, 23% to 38%), and swabs from return air ducts had little growth. Swabs from the PUL unit yielded higher levels of PSA growth than GenM unit swabs (13 % vs. 8%, respectively). MRSA was significantly higher on floors in GenM vs PUL (p < 0.05), but not on counters (p = 0.83). There was no significant difference for Cdiff or PS in GenM vs PUL on floors or counters (p > 0.05), and GN was slightly higher on floors in GenM vs. PUL (p < 0.08). <h3>Conclusions</h3> Viable environmental bacterial species detected in these clinic units differed by unit and surface, ranging from not detectable to very high. Detection of Cdiff on 35% of floors in both units is concerning. Additionally, a 13% PSA rate on PUL unit floors may have implications for cystic fibrosis patients treated there.

Clostridium Difficile Infection in Inflammatory Bowel Disease; Does it Have an Impact?

Background and study aim: Limited data exist on outcomes in inflammatory bowel disease (IBD) patients who develop Clostridium Difficile infection (CDI). The aim of the study to investigate prevalence of CDI in IBD with assessment of the disease behavior in affected patients. Patients and Methods: 30 IBD patients and 15 healthy subjects of matched age & sex as control group. Patient were classified into two groups; group I (15 patients with Crohn’s disease), group II (15 patients with ulcerative colitis) & control group (15 Patients not having IBD). Disease activity for group I was determined by Crohn's disease activity index (CDAI) & for group II by Truelove & Witts score. All patients & controls underwent Computed Tomography Enterocolongraphy, ileo-colonoscopy with ileal & colonic biopsies, and Clostridium Difficile detection & quantification plus detection of toxin A & B using SYBR Green Real-time PCR. Results: 3 patients from group I had CDI and these 3 patients had active disease, one with severe activity (CDAI 550) and two with moderate activity (CDAI 380 & 420). Also 3 patients from group II had CDl and these 3 patients had moderate activity. Only one patient from the control group had CDI carriage (non-toxin producing strain).The rest of patients (38 patients) had no CDI (of them, one patient had mildly active Crohn's disease with CDAI of 200 & two patients had mildly active ulcerative colitis & the others were in remission). Conclusion: Prevalence of toxigenic CDI was 20% among IBD patients and significantly associated with disease activity.

Novel Detection of Norovirus and Double Clostridium difficile in a Closed Cartridge System

Clostridium difficile infection (CDI) has become the main cause of diarrhea-related diseases in domestic (China) inpatients. High-sensitivity and high-specificity detection methods for CDI must be applied clinically for CDI supervisory control. In this paper, we introduce a detection method for C. difficile and Norovirus based on real-time PCR. We developed and optimized a primer-probe for Norovirus targets tcdA and tcdB with remarkably increased detection sensitivity. We then used this method in an integrated cassette, and found increased detection efficiency for Norovirus standards in the cassette compared to C. difficile samples. These results provide a basis for further exploration of automatic testing system design.

Comparative Study of Clostridium difficile Clinical Detection Methods in Patients with Diarrhoea.

Objectives The aim of this study was to evaluate the clinical application of three methods for detecting Clostridium difficile in fecal samples. Methods One hundred and fifty fecal specimens were collected and tested for C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. Results Of 150 specimens, 26 carried both A and B toxin genes, and none of the samples were positive for the binary toxin gene. Toxin-producing C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay. Conclusion The VIDAS GDH assay is useful for initial screening of C. difficile using three methods: (1) the toxigenic culture (TC); (2) the VIDAS enzyme immunoassay (EIA): the VIDAS glutamate dehydrogenase (GDH) assay and toxin A/B assay were used to detect GDH antigen and A/B toxin; and (3) the GeneXpert PCR assay. The toxigenic culture was used as a reference to evaluate the performance of the VIDAS EIA and the GeneXpert PCR assay.

Performance of Different Laboratory Methods for Detection of Clostridium difficile in Animal Samples

Performance of Different Laboratory Methods for Detection of Clostridium difficile in Animal Samples

The diagnostic performance and accuracy of 3 molecular assays for the detection of Clostridium difficile in stool samples, compared with the Xpert® C. difficile assay

This research compares the performance and diagnostic accuracy of three molecular tests for the detection of Clostridium difficile in stool samples, with the Xpert® C. difficile assay.Fifty-nine positive and twenty-five stool negative samples were analyzed by the BDmax™ Cdiff, the Simplexa C. difficile Direct, and the GenomEra™ C. difficile, and compared with the Xpert® C. difficile routinely used in our laboratory.The highest sensitivity was 94.9% for the BDmax™ Cdiff, followed by GenomEra™ C. difficile with 93.2%, and Simplexa™ C. difficile Direct with 89.8%. The specificities of all assays were 100%. GenomEra™ C. difficile had the highest retesting rate (12%). Simplexa™ C. difficile Direct benefits from both short hands-on time and total-turnaround time and 0% retesting.The differences in performance and accuracy between these three molecular assays are insignificant and all may be used as part of the routine algorithm for detection of C. difficile.

Corrigendum to: Detection of antibiotic resistance toxigenic Clostridium difficile in processed retail lettuce

Corrigendum to: Detection of antibiotic resistance toxigenic Clostridium difficile in processed retail lettuce

2358. Understanding the Clinical Implications of Clostridium difficile Detection in the Molecular Age: Colonization vs. Infection in Children Less Than 3 Years of Age

BackgroundInfants have a high rate of asymptomatic Clostridium difficile (CD) colonization (up to 37%) but can rarely develop true CD infection (CDI). However, currently available polymerase chain reaction (PCR) and enzyme immunoassays (EIA) have suboptimal sensitivity/specificity to distinguish CDI from colonization. Recent data from adults showed that lower cycle threshold (Ct) values of a semi-quantitative CD toxin B gene (tcdB) PCR assay in stool correlated with detection of free CD toxin in stool and poor clinical outcomes. We hypothesized that a tcdB PCR assay may be utilized to distinguish CDI from colonization in patients < 3 years old.MethodsSymptomatic patients < 3 years old with CD detected by the BioFire FilmArray Gastrointestinal Panel (FGP) were enrolled 2/2018–3/2019. We performed CD tcdB PCR and toxin A/B/GDH EIA on frozen aliquots of stool in Cary Blair. CDI was defined among those that were tcdB PCR positive as (1) a consistent clinical syndrome (diarrhea + no current laxative use), (2) CD EIA toxin+, (3) symptomatic improvement with CDI-directed treatment, and (4) no alternative etiology of diarrhea identified. Patients who did not meet criteria for CDI were considered colonized. We compared median tcdB PCR Ct values between the CDI and colonized groups using the Mann–Whitney test.ResultsOf 193 FGP CD+ patient samples with charts available for review, 37 (19%) samples were EIA GDH+/toxin+, 121 (63%) were GDH+/toxin− and 35 (18%) were EIA−. 150 (78%) samples had detectable tcdB by PCR. Six (4%) patients met criteria for CDI and 144 (96%) for colonization. Median (interquartile range) tcdB PCR Ct values were 23.8 (22.0–29.5) and 30.5 (26.3–35.8) in patients with CDI and colonization, respectively (P = 0.03).ConclusionUsing a strict clinical and laboratory definition, 4% of evaluable patients < 3 years old met criteria for CDI and had significantly lower tcdB PCR Ct values than colonized patients. A combination of clinical and laboratory criteria, including semi-quantitative tcdB PCR, may help differentiate colonization from CDI in this patient population.Disclosures All authors: No reported disclosures.

Direct detection and characterization of Clostridium difficile from a novel collection device to improve laboratory workflow.

Emergence of Clostridium difficile strains with increased virulence emphasizes the importance of early diagnosis and surveillance of C.difficile infection (CDI). In this study, the new FecalSwab™ collection and transport system was evaluated to improve C.difficile diagnosis. The FecalSwab™ was used for direct C.difficile molecular detection, C.difficile culture/toxigenic culture (TC) and bacterial genomic DNA (bgDNA) extraction. Our results demonstrated that the FecalSwab™ medium could be successfully used as template for Xpert C.difficile binary toxin (BT), regardless of the bacterial load of samples, and for C.difficile culture also after a long storage (30days) of FecalSwab™ tubes at 4°C. Furthermore, good-quality bgDNA was extracted from the FecalSwab™ medium for the majority (75%) of the samples analyzed. Typing was performed to fully characterize C.difficile strains isolated during this study and 17 different PCR-ribotypes (RTs) were identified. The results obtained indicate that the FecalSwab™ can be successfully used not only in daily diagnostic routine of C.difficile but also in surveillance and retrospective studies.

Detection of Clostridium difficile in the environment in a veterinary teaching hospital

The present study focused on detecting the presence of Clostridium difficile on veterinary hospital surfaces of large and small animal areas at the Universidad Complutense of Madrid. Isolated C. difficile strains were further characterized and investigated for antimicrobial susceptibility testing. Of n = 23 sampling area, 17% were positive for the presence of C. difficile.The isolates belonged to PCR ribotypes 078, 014, 039, and 154, of which RT 078 and 014 are also frequently found as human pathogens. Two isolates had high level resistance to metronidazole. These results suggest that the veterinary hospital environment constitutes a potential reservoir of zoonotical transferable C. difficile.

Bacterial infiltration in structural heart valve disease

ObjectivesThe pathology of structural valvular heart disease (sVHD) ranges from basic diseases of rheumatologic origin to chronic degenerative remodeling processes after acute bacterial infections. Molecular genetic methods allow detection of the complete microbial spectrum in heart valve tissues independent of microbiological cultivation. In particular, whole-metagenome analysis is a sensitive and highly specific analytical method that allows a deeper insight into the pathogenicity of the diseases. In the present study we assessed the pathogen spectrum in heart valve tissue from 25 sVHD patients using molecular and microbiological methods. MethodsTwenty-five sVHD patients were selected randomly from an observational cohort study (March 2016 to January 2017). The explanted native heart valves were examined using microbiological methods and immunohistological structural analysis. In addition, the bacterial metagenome of the heart valve tissue was determined using next-generation sequencing. ResultsThe use of sonication as a pretreatment of valve tissue from 4 sVHD patients permitted successful detection of Clostridium difficile, Enterococcus faecalis, Staphylococcus saccharolyticus, and Staphylococcus haemolyticus using microbial cultivation. Histological staining revealed intramural localization. Metagenome analysis identified a higher rate of bacterial infiltration in 52% of cases. The pathogen spectrum included both gram-positive and gram-negative bacteria. ConclusionsMicrobiological and molecular biological studies are necessary to detect the spectrum of bacteria in a calcified heart valve. Metagenome analysis is a valid method to gain new insight into the polymicrobial pathophysiology of sVHD. Our results suggest that an undetected proportion of sVHD might be triggered by chronic inflammation or influenced by secondary bacterial infiltration.

Rapid Assays for Detection of Clostridium difficile and Its Toxins in Hospitalized Patients

Rapid Assays for Detection of Clostridium difficile and Its Toxins in Hospitalized Patients

Evaluating the efficacy of best practice alerts to improve Clostridium difficile early detection in hospital settings: A 6-month interim analysis of the 2-year prospective study.

Introduction:Clostridium difficile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness with high burden on the health-care system.Design:Observational, retrospective, prospective, pre- and post-intervention study on the incidence and prevalence rates of CDIs. The primary outcome is the healthcare-onset CDIs (HO-CDIs) incidence rate and proportion.Methods:Best practice alerts (BPAs) for CDI were developed in electronic medical records and released on July 13, 2016. When high-risk patients for CDI are identified, BPAs are triggered requiring nurses to order contact isolation and stool studies followed by other subsequent BPAs encouraging providers to de-escalate antibiotics and order probiotics. Data on admission count, patient-days, CDIs categories prevalence, and incidence rates were collected for the 24-month preintervention and will be collected for the 24-month postintervention period.Results:An interim analysis comparing the data from the first 6-month postintervention period with the average 6-month data of the preintervention period showed that short-term BPAs use is associated with significant increase in the overall CDI infection rate (71.47 vs. 38.38, P < 0.0001), incidence rate (53.81 vs. 28.76, P < 0.0001), overall prevalence rate (1.86 vs. 1.32, P = 0.001), and admission prevalence rate (1.10 vs. 0.70, P < 0.0001). Despite the observed overall shift from HO toward CO; no statistically significant difference in the HO-CDI event number and proportion was detected (28 [21.4%] vs. 22 [29.1%], P = 0.094).Conclusion:Short-term BPAs use is associated with significant increase in the overall CDI incidence and prevalence along with a non-statistically significant decline in HO-CDI proportion. Final analysis with full sample size is essential to provide a better picture about the long-term effect.