Incidence Of Clostridium Difficile Research Articles

Scutellaria baicalensis Georgi alleviates Clostridium difficile associated diarrhea and its modulatory effects on the gut microbiota

The growing incidence of Clostridium difficile associated diarrhea (CDAD) underscores the urgency for potent treatments. This research delves into the therapeutic potential of Scutellaria baicalensis Georgi (Lamiaceae) root (SR) in addressing CDAD and its influence on gut microbiota. Using a CDAD mouse model and fidaxomicin as a control, SR's impact was measured through diarrhea symptoms, colonic histopathology, and C. difficile toxin levels. Employing the PacBio platform, 16S rRNA full-length gene sequencing analyzed the gut microbial composition and the effect of SR. Results revealed SR considerably alleviated diarrhea during treatment and restoration phases, with a marked decrease in colonic inflammation. C. difficile toxin levels dropped significantly with SR treatment (P < 0.001). While SR didn't augment gut microbiota's overall abundance, it enhanced its diversity. It restored levels of Proteobacteria and Bacteroidetes, reduced Akkermansia spp. and Enterococcus spp. proportions, and modulated specific bacterial species' abundance. In essence, SR effectively mitigates CDAD symptoms, curtails inflammatory reactions, and beneficially restructures gut microbiota, suggesting its potential in advanced CDAD clinical intervention.

Incidence of Clostridium difficile in Patients with Antibiotic Associated Diarrhea

Background: This study was performed to determine the magnitude of Clostridioides difficile infection (CDI) in a tertiary care hospital in patients with antibiotic associated diarrhea (AAD) and to study the risk factors associated with this disease.&#x0D; Methods: A descriptive study was conducted in the department of Microbiology in a tertiary care hospital during December 2019 to May 2021. Stool samples were collected from patients with signs and symptoms of AAD who had been consuming antibiotic or anticancer drugs durng six weeks before the sampling. The samples were subjected to C. difficile glutamate dehydrogenase (GDH) enzyme and CD toxin A &amp; B detection by Enzyme Linked Fluorescent Assay (ELFA). Patient’s demographic features and clinical details were noted and statistically correlated with the test results&#x0D; Results: Among the total 70 samples tested 20 (28%) were positive for GDH alone and 12 (17%) were positive for both GDH and CD toxin A and B. Fluoroquinolones was a significant risk factor in the study. Sepsis and colitis was found to have significant association with C.difficile infection in our study. The crude mortality rate was 17%.&#x0D; Conclusion: Prompt and precise diagnosis and knowledge about the risk factors of CDI helps in effective management and prevention of CDI.

Mechanical and oral antibiotics bowel preparation for elective rectal cancer surgery: A propensity score matching analysis using a nationwide inpatient database in Japan.

The best bowel preparation method for rectal surgery remains controversial. In this study we compared the efficacy and safety of mechanical bowel preparation (MBP) alone and MOABP (MBP combined with oral antibiotic bowel preparation [OABP]) for rectal cancer surgery. In this retrospective study we analyzed data from the Japanese Diagnosis Procedure Combination (DPC) database on 37 291 patients who had undergone low anterior resection for rectal cancer from 2014 to 2017. Propensity score matching analysis was used to compare postoperative outcomes between MBP alone and MOABP. A total of 37 291 patients were divided into four groups: MBP alone: 77.7%, no bowel preparation (NBP): 16.9%, MOABP: 4.7%, and OABP alone: 0.7%. In propensity score matching analysis with 1756 pairs, anastomotic leakage (4.84% vs 7.86%, P < 0.001), small bowel obstruction (1.54% vs 3.08%, P=0.002) and reoperation (3.76% vs 5.98%, P=0.002) were less in the MOABP group than in the MBP group. The mean duration of postoperative antibiotics medication was shorter in the MOABP group (5.2d vs 7.5d, P < 0.001) than in the MBP group. There was no significant difference between the two groups in the incidence of Clostridium difficile (CD) colitis (0.40% vs 0.68%, P=0.250) and methicillin-resistant Staphylococcus aureus (MRSA) colitis (0.11% vs 0.17%, P=0.654). There was no significant difference in in-hospital mortality between the two groups (0.00% vs 0.11% respectively, P=0.157). MOABP for rectal surgery is associated with a decreased incidence of postoperative complications without increasing the incidence of CD colitis and MRSA colitis.

1685. Inappropriate Treatment of Asymptomatic Bacteriuria in Elderly Patients: A Quality Improvement Study

BackgroundAsymptomatic bacteriuria is often misdiagnosed as Urinary Tract Infection (UTI) in elderly patients. Studies suggest that 15-30% of males and 25-50% of females have asymptomatic bacteriuria. We wanted to estimate the percentage of elderly patients who are treated for UTI at our facility and if treatment was appropriate. The goal was to provide the staff with an educational opportunity and help decide if more antibiotic restriction policies would be beneficial.MethodsA retrospective study of patients > 65 years of age who were started on antibiotics for presumed UTI at a single medical center between 7/2018 and 12/2018. Reviewed data included demographics, admitting diagnosis, presence or absence of symptoms of UTI and urine culture results. The data was presented at educational conferences and at antimicrobial stewardship meetings in our facility.Results: 234 patients were started on antibiotics on the basis of pyuria on admission. Of these, only 47% (n=110/234) had symptoms suggestive of UTI. Positive urine cultures were more common in symptomatic patients (n=93/110) compared with asymptomatic patients (n=47/80).In addition, ninety patients had a change in mental status on presentation and were started on antibiotics for suspected UTI. Approximately one third of these patients had eventual negative urine cultures.Conclusion: Elderly patients with pyuria and asymptomatic bacteriuria represent a diagnostic challenge due to their inability to vocalize signs or symptoms of UTI. In addition, a percentage of patients who are asymptomatic and admitted for another reason were often started on antibiotics inappropriately on the basis of pyuria alone. Studies have shown that treating asymptomatic bacteriuria does not add a mortality benefit or lower risk of infection. The CDC emphasizes the importance of assessing for clinical symptoms of UTI before treatment is considered.Our study highlights the importance of provider education in the management of asymptomatic bacteriuria in elderly patients. We also feel that antibiotic restriction policies may limit use of antibiotics for asymptomatic bacteriuria. This would in turn improve patient outcomes and decrease incidence of clostridium difficile associated colitis.Disclosures All Authors: No reported disclosures

Effect of Empiric Treatment of Asymptomatic Bacteriuria in Neurosurgical Trauma Patients on Surgical Site and Clostridium difficile Infection.

Although empiric treatment of urinary tract colonized patients remains a frequent practice in neurosurgery, the value of this practice remains debatable. To analyze the effect of screening and treatment of bacteriuria on surgical site infections, incidence of Clostridium difficile, and mortality in neurosurgical trauma patients. Database queries and direct patient chart reviews were used to gather patient chart data. T-tests, chi-square tests, binary logistic regressions, and propensity matched cohorts comparisons were performed. A total of 3563 admitted neurosurgical trauma patients were identified over an 8 yr period (1524 cranial, 1778 spinal, and 261 combined craniospinal diagnoses). Nine hundred ninety-one patients underwent an operative neurosurgical procedure. Urinalysis was significantly associated with antibiotics exposure in both operative and nonoperative patients (P < .001). Operative patients treated with empiric antibiotics did not have a reduced risk of wound infection (P = .21), including in a propensity matched cohort (P = .52). Patients treated with empiric antibiotics had significantly increased rates of C. difficile infection (P < .001). At last follow-up, neurosurgical trauma patients that developed C. difficile had an increased risk of death (P < .005); antibiotic exposure and death were also significantly associated (P = .018). The association of C. difficile with empiric antibiotics remained significant in a propensity-matched cohort (P = .0024). The routine use of urinalysis and empiric urinary antibiotics for bacteriuria in neurosurgical trauma patients without urinary symptoms increases risk of exposure to antibiotics does not decrease rates of wound infection, and is associated with increased rates of C. difficile infection and death.

2660. Infection Complications Following Mismatched Allogeneic Hematopoietic Cell Transplantation

BackgroundThe use of haploidentitical or HLA mismatched unrelated donors permits allogeneic hematopoietic cell transplantation (HCT) in individuals with otherwise no donors available. Post-transplantcyclophosphamide(PTCy) is used for prevention graft-vs.-host disease (GVHD) in recipients of mismatched donors. We hypothesized that type and incidence of infectious complications following allogeneic HCT would vary according to the type of transplant.MethodsWe systematically assessed viral kinetics and reactivation rates for cytomegalovirus (CMV) in a prospective cohort of mismatched unrelated donor (MMUD) HCT recipients who had PTCy at our center (April 2017–March 2019). In addition, we evaluated the incidence of invasive aspergillosis (IA), invasive candidiasis (IC), bloodstream infection (BSI), pneumonia, Clostridium difficile (CDI), and community-acquired respiratory virus. Haploidentical donor and anti-thymocyte globulin (ATG) treated MMUD recipients were served as historical control groups.ResultsA total of 81 patients were analyzed in 3 groups (Table 1): PTCy MMUD (group 1; n = 22), ATG MMUD (group 2; n = 40) and haploidentical (group 3; n = 19). Whereas the 1 year incidence of CMV viremia was similar across groups, the rate of clinically significant (requiring preemptive therapy) CMV viremia was lower in group 1, compared with groups 2 and 3 (18 vs 53%; P = 0.02). The 1 year incidence of CDI was 47% in group 3 vs. 18% in groups 1 and 2 (P = 0.01). There was no significant difference in the incidence of IA (5–18%), pneumonia (30–42%), BSI (32–55%) and CARVs (28–53%) between groups. There were no cases of IC in this cohort. 1 year infection attributable mortality was lower in group 1 (figure), compared with groups 2 and 3, (9%, 62% and 39%, respectively; P = 0.005).ConclusionCompared with ATG MMUD and haploidentical donor, PTCy MMUD HCT was associated with lower incidence of clinically significant CMV and lower infection attributable mortality. These findings might be related to the contemporary prophylactic strategies used in this patient population. Larger studies are needed. Disclosures All authors: No reported disclosures.

Clostridium difficile infections in teaching hospital in northern Finland

BackgroundThe aim of this study to compare the incidence of Clostridium difficile (CD) infections in the five university hospital districts in Finland based on national register. The clinical findings of CD cases in the Oulu University Hospital (OUH) in one-year cohort were also analyzed.MethodsThe numbers of the CD cases from the national register were used for the hospital district comparison. A retrospective cohort study was conducted among all adult (> 16 years) patients treated in the OUH in 2013, who had positive CD toxin B gene test in stools. The selection of the cohort was based on the data from the OUH microbiology laboratory and the clinical characteristics were collected from hospital records.ResultsThe incidence of CD findings in 2013 was higher in the OUH district than in the other four university hospital districts: 159 vs. 70 to 84 per 100,000 inhabitants.In 2013, 261 patients had CD infection treated in the OUH. The yearly number of CD cases treated in the OUH in 2009–2016 varied between 221 and 287, and the corresponding proportion of positive CD findings out of all samples taken varied from 10.0 to 17.8%. A recurrent infection was seen in 58 patients (22%) while the all-cause 30 day mortality was 7.3%.ConclusionsDiagnostic strategies differed nationally, which may explain the differences in CD incidence between the university hospital districts. In the OUH, no increase in the number of CD infections was seen in 2009–2016. Main characteristics of the patient cohort in the OUH were in harmony with earlier literature.

973. Inter-facility Patient Sharing and Clostridium difficile Incidence in the Ontario Hospital Network: A 13-Year Longitudinal Cohort Study of 116 Hospitals

BackgroundInter-facility patient movement plays an important role in the dissemination of antimicrobial resistance and C. difficile infection (CDI) throughout healthcare systems. However, the relative performance of different patient sharing metrics for predicting CDI incidence is not known. We compared 3 different measures of inter-facility patient sharing as they relate to CDI incidence in Ontario facilities.MethodsA retrospective cohort analysis was used to predict incident CDI (ICD-10 = A04.7 identified from Discharge Database records) across Ontario hospitals (Nhospitals = 116) between April 1, 2003 to March 31, 2016. Patients with a stay of <3 days and those with a history of CDI in the prior 90 days were excluded from the risk set but not from patient sharing metrics. Poisson regression models with facility-level random effects were used to predict facility CDI incidence (per 1,000 admissions) and measure the percent change in facility-level variance (PCV). The 3 metrics of inter-facility patient sharing included: (1) “importation”—the rate of patients with a discharge from another distinct facility in prior 90 days, (2) “incidence-weighted importation”—equal to importation weighted by the incidence of CDI in the previous facility, and (3) “case importation”—importation of patients with a history of CDI.ResultsOver the 13-year period, we observed 58,427 cases of healthcare-associated CDI among 12,750,000 admissions. Facility CDI incidence ranged from 2.9 to 19.6 per 1,000 admissions (6.8-fold range). Patient sharing metrics were strongly related to facility CDI incidence (figure). In models adjusting for facility risk factors, all 3 measures still explained an important portion of inter-facility variation in CDI incidence: importation (PCV = 5%, P = 0.01), incidence-weighted importation (PCV = 15%, P < 0.001), and “case importation” (PCV = 48%, P < 0.001).ConclusionWe observed a substantial variation in facility CDI incidence that was explained by linkages between acute care facilities, especially linkage to other facilities with a high incidence of CDI. Facility infection prevention staff should consider incorporating the facility CDI incidence into risk stratification assessments of patient transfers. Disclosures All authors: No reported disclosures.

515. Estimating the Effect of Proton Pump Inhibitor Stewardship in Reducing Clostridium difficile Transmission

BackgroundAntibiotic stewardship programs (ASPs) have been successful in reducing the incidence of Clostridium difficile (CDI) by reducing patient exposure to antibiotics, especially fluoroquinolones. Proton pump inhibitors (PPIs), while less pronounced as a risk factor for CDI, are widespread in their use, often for much longer durations than most courses of antibiotics. PPI stewardship may be a potential target for ASPs.MethodsWe used a mathematical model of C. difficile transmission in an ICU to estimate the effects of a co-occurring antibiotic and PPI stewardship program. This approach captured any synergistic dynamics between the two interventions (e.g., patients taking both PPIs and antibiotics) while being able to independently estimate their effects. This model simulated for five years and 5,000 iterations, with the reduction in antibiotic and PPI use independently varied independently between 0% and 40%. The rates of C. difficile were then estimated using Poisson regression models accounting for admission volume.ResultsBoth antibiotic and PPI stewardship reduced the number of incident C. difficile cases within the simulated ICU. A 30% decrease in fluoroquinolone use corresponded with a 21.9% decrease in incident C. difficile cases (P < 0.001), while a 30% decrease in PPI use corresponded with a 9.1% reduction (P < 0.001) in incident cases. There was no evidence of a synergistic effect between the two interventions (P = 0.60). PPI stewardship also decreased length of stay, resulting in a 7% increase in admissions in the simulated ICUs (P < 0.001).ConclusionPPI stewardship might prove a valuable adjunct to existing antibiotic stewardship programs. The reductions in C. difficile transmission were more modest for PPI stewardship as compared with programs targeting fluoroquinolones. PPI stewardship, however, may reach different patient populations, and may represent an additional area for substantial improvement even in facilities that have made substantial gains in reducing fluoroquinolone use.Disclosures All authors: No reported disclosures.

Do we need new trials of procalcitonin-guided antibiotic therapy?

Using biomarkers as a guide to tailor the duration of antibiotic treatment in respiratory infections is an attractive hypothesis assessed in several studies. Recent work aiming to summarize the evidence assessed the effect of a procalcitonin (PCT)-guided antibiotic treatment on outcomes in acute lower respiratory tract infections (LRTI), suggesting that significant reductions in antibiotic duration occur when using a PCT-guided algorithm. However, controversial evidence also suggested PCT-guided algorithms were associated with increased antibiotic duration and increased incidence of Clostridium difficile, without any impact on mortality, in real-world settings. So, although using PCT-guided antibiotic stewardship is promising, after more than a decade of randomized controlled trials on this topic the evidence in its favor is still less than compelling due to limitations in trial design, not taking into consideration fundamental aspects of PCT biology, and the absence of evidence-based antimicrobial duration in intervention and control groups. In this commentary we highlight some questions and limitations of primary PCT study data that might impact interpretation and clinical use of PCT at the bedside.

Savremeni pristup u terapiji infekcija izazvanih sa Clostridium difficile

Infection caused by Clostridium difficile (CDI) occurs as a result of imbalance of bacteria in intestinal tract mainly due to previous exposure to wide-spectrum systemic antibiotics. Nowadays, it is recognized as one of the most frequent infections acquired in hospitals. Contemporary clinicians often face an increased incidence of fulminant and recurrent CDIs that are accompanied with a number of colectomies, prolonged stay in hospitals, fatal outcome, and rising healthcare costs. Traditional antibiotics for CDI, such as metronidazole, vancomycin or fidaxomicin, have been linked to certain treatment limitations in previous studies. Thus, the aim of this narrative mini literature review was to critically evaluate efficiency of each of the recommended modern therapy modalities for CDI, as well as the frequency and severity of adverse events associated with their use. Based on current knowledge, the range of standard antibiotics approved for treatment of initial or recurrent CDI remains quite limited. Regardless of severity of CDI, oral or rectal vancomycin should be considered as the first-line therapeutic option in adults and children, while fidaxomicin or metronidazole could be an appropriate alternative. The other potentially effective antimicrobials against CDI, such as rifaximin, nitazoxanide, fusidic acid, tigecyclin, bacitracin and use of probiotics cannot be advised as the therapy of choice, as they did not provide any advantage over vancomycin or fidaxomicin in prior investigations. In an attempt to solve the problem of recurrent CDI events, which is one of the most important challenges facing health professionals today, adjunct use of human monoclonal antibody against toxin B (bezlotoxumab) or instillation of normal colonic bacteria obtained from healthy donor into patient's intestine (Fecal Microbiota Transplantation), could be effective and safe approach where available. Besides clinical development of innovative therapy for CDI, such as new antibiotics and vaccines, primary focus should be on effective prevention of this infection, in terms of improving rational use of broad-spectrum systemic antibiotics and proton pump inhibitors.

Moxifloxacin versus levofloxacin or ciprofloxacin prophylaxis in acute myeloid leukemia patients receiving chemotherapy.

Patients receiving intensive chemotherapy regimens are at high risk for infectious complications due to prolonged neutropenia and hospital stay. Fluoroquinolone antibiotics, mainly levofloxacin and ciprofloxacin, are the mainstay of prophylactic therapy for these patients. There is limited data regarding the utilization of other quinolone antibiotics including moxifloxacin in this setting. A retrospective chart review was completed comparing the use of prophylactic moxifloxacin to that of levofloxacin or ciprofloxacin during periods of prolonged neutropenia. Adult patients admitted to a community teaching hospital while receiving induction or reinduction chemotherapy for acute myeloid leukemia were included. One hundred and forty-one patients were included in this study. The two groups displayed slight heterogeneity: patients receiving moxifloxacin were approximately 10years younger (54 vs. 64years, p=0.01), more likely to receive granulocyte colony stimulating factor (GCSF) (45 vs. 19%, p=0.001), and neutropenic for a longer duration (23 vs. 19days, p=0.009). The incidence of febrile neutropenia (76 vs. 81%, RR 0.93, 95% CI 0.78-1.11, p=0.42) and of documented infections (27 vs. 33%, RR 0.82, 95% CI 0.49-1.36, p=0.44) was similar between those receiving moxifloxacin and levofloxacin/ciprofloxacin, respectively. Hospital readmission for an infectious issue within 30days of hospital discharge (9 vs. 5%, p=0.39) was also similar between groups as was the incidence of Clostridium difficile (9 vs. 9%, p=0.96). Moxifloxacin may be an alternative to levofloxacin or ciprofloxacin in patients with a prolonged risk of febrile neutropenia requiring prophylaxis.

Probiotic containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophiles (ACTIMEL) for the prevention of Clostridium difficile associated diarrhoea in the elderly with proximal femur fractures.

The incidence of Clostridium difficile associated diarrhoea (CDAD) is greater in elderly patients. Probiotics may have a beneficial effect in the prevention of CDAD. However, their effect in elderly orthopaedic patients has not been previously reported. Between April 2013 and April 2014, 105 patients admitted with femoral neck fractures, and who required 3days of antibiotics for infection of any cause, were prescribed the probiotic ACTIMEL until 3days after the last antibiotic dose. The incidence of CDAD was compared with historical controls (April 2011￢ﾀﾓApril 2012). There was no significant reduction in the incidence of CDAD in patients receiving probiotics (OR: 0.9; 95% CI 0.27￢ﾀﾓ2.91; p=0.8) and therefore we cannot recommend the use of ACTIMEL containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophiles for this purpose in this patient group.

The Drivers of Acute and Long-term Care Clostridium difficile Infection Rates: A Retrospective Multilevel Cohort Study of 251 Facilities.

Drivers of differences in Clostridium difficile incidence across acute and long-term care facilities are poorly understood. We sought to obtain a comprehensive picture of C. difficile incidence and risk factors in acute and long-term care. We conducted a case-cohort study of persons spending at least 3 days in one of 131 acute care or 120 long-term care facilities managed by the United States Veterans Health Administration between 2006 and 2012. Patient (n = 8) and facility factors (n = 5) were included in analyses. The outcome was the incidence of facility-onset laboratory-identified C. difficile infection (CDI), defined as a person with a positive C. difficile test without a positive test in the prior 8 weeks. CDI incidence in acute care was 5 times that observed in long-term care (median, 15.6 vs 3.2 per 10000 person-days). History of antibiotic use was greater in acute care compared to long-term care (median, 739 vs 513 per 1000 person-days) and explained 72% of the variation in C. difficile rates. Importation of C. difficile cases (acute care: patients with recent long-term care attributable infection; long-term care: residents with recent acute care attributable infection) was 3 times higher in long-term care as compared to acute care (median, 52.3 vs 16.2 per 10000 person-days). Facility-level antibiotic use was the main factor driving differences in CDI incidence between acute and long-term care. Importation of acute care C. difficile cases was a greater concern for long-term care as compared to importation of long-term care cases for acute care.

Education and engagement of front line staff to lower incidence of Clostridium difficile

Education and engagement of front line staff to lower incidence of Clostridium difficile

Tu1718 - Incidence of Clostridium Difficile in Patient Treated with Helicobacter Pylori Eradication Therapy

Tu1718 - Incidence of Clostridium Difficile in Patient Treated with Helicobacter Pylori Eradication Therapy

Is More Always Better? Effect of a Combination Pseudomonas Antibiogram on Levofloxacin Use and Patient Outcomes for Pneumonia in a Large Community Hospital

BackgroundEvidence suggests that combination therapy for Pseudomonas pneumonia only provides mortality benefit in critically ill patients. In November 2015, the Antimicrobial Stewardship Subcommittee at Baptist Memorial Hospital-Memphis (BMH-Memphis) developed a combination Pseudomonasantibiogram and guideline, based on local susceptibilities, for critically ill patients with Hospital Acquired Pneumonia (HAP), Health Care Associated Pneumonia (HCAP), or Ventilator Associated Pneumonia (VAP).MethodsThis is a single center, retrospective study evaluating patients admitted to the BMH-Memphis medical intensive care unit (MICU) and surgical intensive care unit (SICU) with a diagnosis-related group (DRG) code for HAP, HCAP, or VAP.The primary objective of this study was to compare levofloxacin days of therapy per 1000 patient-days (DOT/1000 patient-days) before and after implementation of the combination Pseudomonas antibiogram guideline at BMH-Memphis. Secondary objectives included a comparison of individual levofloxacin orders, 30-day mortality, hospital length of stay (LOS), ICU LOS, 90-day incidence of extended spectrum β-lactamases (ESBLs), and 30-day readmission rates and incidence of Clostridium difficile. Adverse events including acute kidney injury and QTc prolongation were also evaluated pre- and post-implementation of the guideline.ResultsA total 150 patients were included in this study to meet power for the primary objective. Levofloxacin DOT/1000 patient-days was reduced by 3.4 days in the post-implementation period (P < 0.001) with a 63% reduction in individual levofloxacin orders (P < 0.001). Furthermore, there were significantly lower 30-day mortality rates in the post-implementation period, which persisted in a multivariate logistic regression analysis (P = 0.01). There was no difference in hospital or ICU LOS, 30 day readmission rates or incidence of Clostridium difficile,or 90-day incidence of ESBLs. There was also no difference in adverse events between the two study periods.ConclusionThis study demonstrates that the implementation of a combination anti-pseudomonal guideline can decrease levofloxacin use while reducing 30-day mortality rates without increasing hospital or ICU LOS.Disclosures All authors: No reported disclosures.

Epidemiology and outcome ofClostridium difficileinfections in patients hospitalized in Internal Medicine:findings from the nationwide FADOI-PRACTICE study.

Background Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy.MethodsPRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy.ResultsAmong the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days.ConclusionsOur results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2–3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1961-9) contains supplementary material, which is available to authorized users.

Epidemiological Assessment of the Association Between Antibiotic Consumption and Clostridium difficile Incidence at an Academic Medical Center

Epidemiological Assessment of the Association Between Antibiotic Consumption and Clostridium difficile Incidence at an Academic Medical Center

The Interplay Between Acute and Long-Term Care Clostridium difficile Incidence in the United States Veterans Health Administration: A Retrospective Cohort Study of 169 Facilities

The Interplay Between Acute and Long-Term Care Clostridium difficile Incidence in the United States Veterans Health Administration: A Retrospective Cohort Study of 169 Facilities